Hanna House Ridley

Allegation investigated: Facility has a scabies outbreak

Licensing Program Analyst (LPA), Alviso, conducted a complaint inspection, at approximately 11:25am on 8/11/26, and met with Administrator, David Hanna, and Resident Care Coordinator, Karrie Hanna. Reporting party alleges that "facility has a scabies outbreak". The LPA reviewed resident's (R1) records, including care plan, hospice records, medical assessment, medications list/Dr's Orders, and Kaiser medical records. LPA reviewed resident R2's records. The LPA interviewed staff, and other related parties. The investigation revealed that R1 went out to Kaiser on 4/5/26, and was medically assessed for health concerns, including being very itchy. The Kaiser medical records identify that the resident is diagnosed with diffuse pruritis, a wide spread or generalized, itchy skin affecting the whole body; Per records, R1 diagnosed with Pruritis, a medical term for an itch that creates a strong desire to scratch. Record states there was a concern reported that R1 was very itchy, and it may be scabies. Continued on LIC9099C... Unsubstantiated R1 was not identified as testing positive for scabies, but was provided Ivermectin medication due to a concern of possible scabies. Medical record identifies R1 as receiving methadone medication, which can cause itching as a side effect, per record reviews. R1 is diagnosed with chronic venous stasis edema, which frequently causes persistent itching. Per review of hospice records, hospice Nurses were seeing the resident and were observing that R1 was itchy; R1 was being provided medications for itchy symptoms, but these were not for treatment of scabies and/or provided due to a diagnosis of scabies. LPA obtained copies of records. Per review of R2's records, there was no medical diagnosis of scabies; R2 was seen by a Physician and was found to not have scabies. LPA obtained copies of records. The facility has no scabies outbreak, per Administrator. There was no information and/or documentation obtained to support that a violation had occurred regarding "facility has a scabies outbreak". Based on LPA's investigation, including medical records, medication records, hospice records, interviews with staff, other related parties, the allegation is Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies cited. Exit interview was conducted with the Administrator David Hanna.the state’s words, verbatim · CDSS document, Aug 11, 2026 · control 21-AS-20260407105626

Allegation investigated: Neglect/lack of supervision, resulted in resident developing multiple pressure injuries Staff locks resident in their room Staff handles resident roughly Staff leaves resident in soiled incontinence briefs for extended periods of time Licensee does not ensure facility is kept free of incontinent odors

Licensing Program Analyst (LPA), Alviso, conducted a complaint inspection, at approximately 11:25am on 8/11/26, and met with Administrator, David Hanna, and Resident Care Coordinator, Karrie Hanna. Reporting party alleges that "neglect/lack of supervision, resulted in resident developing multiple pressure injuries, staff locks resident in their room, staff handles resident roughly, staff leaves resident in soiled incontinence briefs for extended periods of time, licensee does not ensure facility is kept free of incontinent odors". The LPA reviewed resident's (R1) records, hospice plan/care plan, hospice records, medications list/Dr's Orders, incidents, and Kaiser medical records. The LPA interviewed staff, and other related parties regarding the allegations. The investigation revealed that resident R1 had moved into the facility with wounds, pressure injuries, and was moved into the facility receiving hospice care. Per record reviews, the resident R1 is susceptible to wounds due to their health and diagnosis. Per review of hospice records, there is no documentation/progress notes from hospice staff/nurses that resident was neglected and/or not being supervised and/or neglect causing pressure injuries/wounds. Hospice was in and out of the facility to see the resident and provide skilled care as needed, per hospice plan. There was no information obtained in the investigation to support that a violation had occurred.....Continued on LIC9099C... Unsubstantiated R1 would transfer into their wheelchair from their bed and would transfer from their wheelchair into bed. R1 was able to roll their wheelchair to their bedroom door and open the door knob; The bedrooms all have door knobs that open from inside by turning the doorknob. The bedroom doors of all residents do not lock from the inside, they may be open by residents at any time. There was no information obtained in the investigation to support that a violation had occurred Per investigation, staff interviewed deny that R1 was handled roughly; Staff interviewed did not observe any staff handle R1 roughly. Per interviews, R1 would not agree to assistance with ADL needs at times, and staff would have to come back and ask to assist R1 as needed. There was no information obtained in the investigation to support that a violation had occurred. R1 was incontinent, and required assistance with changing briefs, and being cleaned as needed. Staff would assist R1 with showering if needed. Per interviews, staff would offer to assist R1 as needed, and sometimes R1 would agree and let the staff care for them; If R1 would say no, not now, staff would return after a few minutes, and ask to assist R1 with incontinent care needs. Staff stated they clean up after changing a resident and if the resident was changed in their room, not in the bathroom, the room may have the smell of a brief change having been done recently. There was no information obtained in the investigation to support that a violation had occurred. Per investigation, the facility has a schedule of cleaning throughout the day at specific times in all restrooms that are used frequently by all residents, and resident's who are changed in their rooms, staff will clean in the room to help rid the room of any lingering incontinent odors. It is unknown how R1's room was at the time of the complaint filing, as R1 had moved out of the facility. LPA observed that the facility has cleaning products, bathroom/resident room maintenance schedules to help ensure incontinent odors are managed appropriately. There was no report of abuse received from the hospice agency regarding the care R1 was receiving from the facility staff; In review of hospice records there was no documentation recorded by hospice staff regarding concerns of neglect in the care of R1 by the facility staff. There was no information and/or documentation obtained to support that violation had occurred regarding "neglect/lack of supervision, resulted in resident developing multiple pressure injuries, staff locks resident in their room, staff handles resident roughly, staff leaves resident in soiled incontinence briefs for extended periods of time, licensee does not ensure facility is kept free of incontinent odors". Based on LPA's investigation, including medical records, medication records, hospice records, interviews with staff, other related parties, the allegations are Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies cited. Exit interview was conducted with the Administrator David Hanna.the state’s words, verbatim · CDSS document, Aug 11, 2026 · control 21-AS-20260403110400

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Alviso, conducted a Required - 1 Year Inspection, on 6/25/26 at approximately 1:15pm, and met with Administrator David Hanna,and Resident Care Coordinator (RCC) Karrie Hanna. Currently twenty-five (25) residents in care; There are four (4) residents are on Hospice. Hospice care waiver approved for eight (8) residents. Facility has a required infection control plan. Facility has a required emergency disaster plan. LPA reviewed seven (7) resident files, including medication records and observed storage of medications.. All files were complete. LPA reviewed seven (7) staff files. All staff have required DOJ criminal record clearance. LA reviewed staff training. All care staff have first aid certification and CPR certification. Staff have required training. LPA toured the facility. There was a sufficient supply of cleaners/disinfectants, paper products, linens, and hygiene products. Facility had a sufficient supply of food. LPA observed residents' having their noon/lunch meal during the inspection. The facility bathrooms had grab bars for resident use, including non-slip/textured flooring in showers for residents use as needed. There was sufficient lighting in the facility, in common areas, bathrooms, and resident rooms checked, for residents use. Fire extinguishers were fully charged, serviced, and tagged as required. Medications were locked up and inaccessible to residents in care. Disinfectants/cleaners were locked up and inaccessible to residents in care. There was sufficient supply of hygiene products, paper products, cleaners/soaps, and personal protective equipment (PPE) supplies. Continued on LC809C... LPA is requesting the following documents be updated and submitted by 7/25/26: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610-Emergency Disaster Plan (9 pages)- if any updates submit a copy- If no changes, submit copy of last page (signed/dated) LIC400- Affidavit of Client Cash Resources Copy of Bond if handling cash, per LIC400 Copy of Current Liability Insurance Infection Control Plan- if any updates submit a copy- If no changes, submit copy of last page (signed/dated) Poster of Residents Copy of current Administrator Certificate There were no deficiencies cited during today's inspection. Exit interview was conducted with Administrator David Hanna.the state’s words, verbatim · CDSS document, Jun 25, 2026

Allegation investigated: Staff does not ensure that skilled staff provides care to resident Staff does not allow residents to possess personal belongings Staff confines residents to chairs Staff did not monitor resident for change in condition Staff do not communicate with responsible party regarding resident's care Staff did not safeguard a resident's medical information Staff handles residents in a rough manner Staff do not assist resident with showering

Licensing Program Analyst (LPA), Alviso, conducted a complaint investigation,and met with Karrie Hanna, Resident Care Coordinator. Licensee/Administrator David Hanna arrived to meet with the LPA within an hour. Reporting party alleges that "staff does not ensure that skilled staff provides care to resident, staff does not allow residents to possess personal belongings, staff confines residents to chairs, staff did not monitor resident for change in condition, staff do not communicate with responsible party regarding resident's care, staff did not safeguard a resident's medical information, staff handles residents in a rough manner, staff do not assist resident with showering." The LPA reviewed resident's (R1) records, including care plan, medical assessment, medications list/Dr's Orders. The LPA reviewed facility records, including medication assistance records for resident (R1). LPA conducted interviews with staff, and other related parties. Continued on LIC9099C.. Unsubstantiated The investigation revealed that R1 had their blood pressure checks done by resident care coordinator and by some staff. R1 took their blood pressure medication often, and would give the information to the staff, per interviews. Facilities don't have to have medical staff on shift or on all shifts, as it is not a hospital but assisted living for elderly; Facility doesn't have medical staff as part of their program, though RCC is a RN. There was no sufficient information obtained to support that the staff took the resident's blood pressure wrong due to there were no records of blood pressure checks and readings by facility staff, this was not done regularly as needed and required. This was cited as part of the medication deficiency on 11/24/25 of this complaint investigation. There was no information obtained supporting that residents' are not allowed personal belongings, such as cell phones and/or other items. This was investigated recently regarding a separate filed complaint. Per investigation and interviews, there was no information to support that residents are confined to chairs by staff, that staff didn't monitor resident for change in condition. There was no information obtained supporting residents' are handled roughly by staff or that resident's medical information was not safeguarded by staff. There was insufficient information to support violations occurred regarding resident not assisted with showering and/or staff didn't communicate with responsible party regarding resident's care. Based on LPA's review of records, including medical records, medication records, interviews with staff and other related parties, and related information obtained during the investigation, the allegations of "staff does not ensure that skilled staff provides care to resident, staff does not allow residents to possess personal belongings, staff confines residents to chairs, staff did not monitor resident for change in condition, staff do not communicate with responsible party regarding resident's care, staff did not safeguard a resident's medical information, staff handles residents in a rough manner, staff do not assist resident with showering" are Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies cited. Exit interview was conducted with the Administrator David Hanna. Staff/S2 responded to R1, and provided them a medication pill, but before giving R1 the medication, S2 stated "your family thinks that I am incompetent". R1 is a dependent resident of the facility and this is an inappropriate comment to the resident by facility staff. There is sufficient information obtained to support a personal right's violation occurred. The deficiency will be cited, 87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities- In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs, see LIC9099D. The preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited. Failure to correct deficiencies by due dates, may result in additional deficiency citations and/or civil penalties being assessed. Exit interview conducted with the Administrator David Hanna. Appeal Rights provided.the state’s words, verbatim · CDSS document, Jan 5, 2026 · control 21-AS-20250904124021

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jan 19, 2026

87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities- In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Per LPA's investigation, resident (R1) was not feeling well and requested assistance and help with their needs, including needed medication from staff/S2. Staff/S2 responded to R1, and provided them a medication pill, but before giving R1 the medication, S2 stated "your family thinks that I am incompetent". R1 is a dependent resident of the facility and this is an inappropriate comment to the resident by facility staff. This is a risk to resident's personal rights.the state’s words, verbatim · CDSS document, Jan 5, 2026

Plan of correction: Licensee/Administrator to ensure that residents' rights are not violated, per regulations. Administrator to ensure they hold an in-service training with all staff regarding "resident rights". Submit proof of training, and plan of future compliance by 1/19/26.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Alviso conducted a case management inspection, on 1/5/26 at approximately 1:20pm, and met with Karrie Hanna, Resident Care Coordinator. The case management is being conducted to cite a deficiency that was unrelated to complaint allegations being investigated at the facility, see complaint report of today, 1/5/26. Per investigation of earlier today, LPA conducted interviews, reviewed resident records, reviewed facility records, and reviewed information/documents obtained, it was revealed that the facility had not cleaned resident's bed linen(s) that had been urinated on by R1, on 9/5/25; The bed linens were found to still be on resident's bed with the urine dried on them, the bed and room smelling of urine when moving R1's personal belongings out on 9/6/25. LPA obtained sufficient information to support a violation occurred regarding incontinent care procedures for R1 as needed. The following deficiency will be cited regarding the above on resident (R1) incident and information obtained during today's inspection, 87625(b)(3) Managed Incontinence- In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence, see LIC809D. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited. Exit interview conducted with the Administrator David Hanna. Appeal Rights Provided to the Administrator.the state’s words, verbatim · CDSS document, Jan 5, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(3) · Plan of correction due date: Jan 9, 2026

87625(b)(3) Managed Incontinence- In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. it was revealed in LPA's investigation that the facility had not cleaned resident's bed linen(s) that had been urinated on, on 9/5/25; The bed linens were found to still be on resident's bed with the urine dried on them, the bed and room smelling of urine, this was on 9/6/25. LPA obtained sufficient information to support a violation occurred regarding incontinent care procedures for R1 as needed. This is a risk to resident rights.the state’s words, verbatim · CDSS document, Jan 5, 2026

Plan of correction: Licensee/Administrator to ensure that the facility is free of urine/feces/ incontinent odors as required by regulations. Ensure residents are clean and dry, including bed linens, and resident rooms are cleaned and free of incontinent odors. Hold an in-service training with all staff. Submit proof of training by 1/19/26. Submit plan of future compliance and plan of completing training with staff by POC 1/9/26.

Allegation investigated: Staff are not following resident's medication Physician order as required

Licensing Program Analyst (LPA), Alviso, conducted a complaint investigation,and met with Karrie Hanna, Resident Care Coordinator. Reporting party alleges that "staff are not following resident's medication Physician order as required." The LPA reviewed resident (R1) records, including medication records. The LPA reviewed facility records, including medicationr assistance records for resident (R1). LPA conducted interviews with staff, and other related parties. The investigation revealed that R1 has two medications that require blood pressure checks prior to providing the medication to the resident. One medication is provided once a day if able to be provided, and the second medication is provided three times a day if able to be provided; This medication is only provided if in-line with the Physician's order of the resident's blood presure reading, athe time the medication is to be given, per order. Resident's blood pressure checks are to be done while the resident (R1) is standing, per physician instructions. In review of medication records by the facility, there was no specific record information of the actual blood pressure of R1 when medications were said to have been given, and no record showing blood pressure reading, month, days, and time the medications were said to have been provided to the resident (R1). Continued on LIC9099C.. Substantiated Per interviews with staff, S2 stated there was no record of blood pressure readings or every single day and time the medications were provided to the resident. S2 stated they didn't track the blood pressure readings. The resident R1 has the blood pressure readings in their book. R1 didn't return to the facility after going to the hospital on 9/5/25 due to not feeling well. LPA discussed regulation information regarding medications, medication assistance, and maintaining medication records appropriately and accurately to reflect medications are being provided to the resident as required/needed. Ensuring compliance with Dr's Orders, and Dr's instructions, including records to show medication is being provided as required. Per investigation, facility failed to provide R1's medications per Physician orders as required. There was no record of blood pressure (BP) readings, no record of month/days, time, showing the medications were provided, and record of acceptable BP reading of R1. S2 stated they didn't track the blood pressure readings, staff would look at record of blood pressure readings from R1. Sufficient information obtained to support violations occurred regarding "staff are not following resident's medication Physician order as required." Allegation is Substantiated. This deficiency will be cited, 87465(a)(4) Incidental Medical and Dental Care- 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: The licensee shall assist residents with self administered medications as needed, see LIC9099D. The preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited. Failure to correct deficiencies by due dates, may result in additional deficiency citations and/or civil penalties being assessed. Exit interview conducted with the Resident Care Coordinator, Karrie Hanna. Appeal Rights provided.the state’s words, verbatim · CDSS document, Nov 24, 2025 · control 21-AS-20250904124021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Nov 25, 2025

87465(a)(4) Incidental Medical and Dental Care- A plan for incidental medical and dental care shall be developed by each facility: The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Per investigation, facility failed to provide R1's medications per Physician orders as required. There was no record of blood pressure (BP) readings, no record of month/days, time, showing the medications were provided, and record of acceptable BP reading of R1. S2 stated they didn't track the blood pressure readings, staff would look at record of blood pressure readings from R1. This is a health & safety risk to residents' in care.the state’s words, verbatim · CDSS document, Nov 24, 2025

Plan of correction: Licensee/Administrator to ensure that residents’ medications are provided as needed, per Physician’s orders. Ensure that records are documented and maintained when medications have specific instruction, such as within a blood pressure reading and/or not over or under a specific blood pressure reading. Ensure staff providing blood pressure checks are qualified to be able to provide blood pressure checks to a resident. Submit plan, 12/3/25, on ensuring future compliance with this regulation and submit how the facility will document, and track medications as needed, per instructions by Physicians. Plan of correction should include information documented regarding providing medications, prior to providing and/or after providing them, per order. POC due 11/25/25.

Allegation investigated: Resident's medication is not being provided as prescribed Resident's personal rights are being violated

Licensing Program Analyst (LPA) Alviso, conducted a complaint inspection, approximately 10:00am on 10/20/25, and met with Resident Care Coordinator(RCC) Karrie Hanna. Administrator David Hanna arrived to to meet with the LPA. Reporting party alleges that "resident's medication is not being provided as prescribed, and resident's personal rights are being violated". The LPA reviewed resident, R1, records, including medication records, medical documentation,medical assessment, facility care plan, and Hospice Care plan; The LPA interviewed staff, and other related parties regarding the allegations. The investigation revealed that per record reviews, medications are being provided to the resident, and they are being povided as prescribed by the Physician. R1's medication list was provided by the hospital upon R1's discharge to the facility, on 10/10/25. R1 had a change in medications by the Physician on 10/11/25. Hospice agency was at the facility, on 10/10/25 and 10/11/25, to see the resident. Hospice is to oversee resident's medication and adjust the medication as needed, with Physician order/approval. Continued on LIC9099C.. Unsubstantiated Hospice agency was at the facility, on 10/10/25 and 10/11/25, to see the resident. Hospice will be overseeing resident's medication (s) and adjust the medication as needed, with Physician approval/order. Per review of hospice records, there was no documentation regarding concerns with how resident's medications were being provided to them, and no concerns on the care being provided to the resident. LPA observed the lunch meal being provided to residents', including R1. Per interviews with staff and other parties, meals are always provided, snacks, and if someone wants seconds of food and/or another item, the facility will provide this to the resident. The resident's personal phone had no charger, and staff would charge the phone for the resident. This would be done in the kitchen and/or in the facility office. R1's responsible party decided to collect the cell phone while at the facility. LPA interviewed staff and other parties regarding staff speaking inappropriately to the residents' and/or staff handling residents in a rough manner. Per investigation and review of records, including medical records, medication records, hospice records, interviews with staff, interviews with other related parties, and staff records, there was no information obtained to support that violations had occurred regarding the allegations reported. Based on LPA's review of records, including medical records, medication records, hospice records, interviews with staff, other related parties,staff records, and related information obtained during the investigation, the allegations of "resident's medication is not being provided as prescribed, and resident's personal rights are being violated" are Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies cited. Exit interview was conducted with the Administrator David Hanna.the state’s words, verbatim · CDSS document, Oct 20, 2025 · control 21-AS-20251017145442

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA), Alviso, conducted a Required - 1 Year Inspection, on 7/21/25, and met with Administrator David Hanna, and Resident Care Coordinator (RCC) Karrie Hanna. Currently twenty-one (21) residents in care; There are two (2) residents are on Hospice. Hospice care waiver approved for eight (8) residents. Facility has a required infection control plan. Facility has a required emergency disaster plan. LPA reviewed seven (7) resident files. All files were complete. LPA reviewed five (5) staff files. All staff have required criminal record clearance. Per file reviews, staff have first aid certification and CPR certification. Staff have required training. LPA toured the facility. There was a sufficient supply of cleaners/disinfectants, paper products, linens, and hygiene products. Facility had a sufficient supply of food. LPA observed residents' having their noon/lunch meal during the inspection. The facility bathrooms had grab bars for resident use, including non-slip/textured flooring in showers for residents use as needed. There was sufficient lighting in the facility, in common areas, bathrooms, and resident rooms checked, for residents use. Fire extinguishers were fully charged, serviced, and tagged as required. Continued on LIC809C... Facility was observed to be clean and orderly during the inspection. All smoke alarms were in all required rooms, and facility has carbon monoxide detectors. All bathrooms had soap supply for use, and had paper towels available for residents' use. All medications were locked up and inaccessible to residents in care. All cleaners/disinfectants were locked up and inaccessible to residents' in care. Outside facility grounds were clean, pathways free and clear of obstruction, and there was outside furniture for residents' use. LPA is requesting the following documents be updated and submitted by 8/21/25: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610-Emergency Disaster Plan (9 pages)- if any updates submit a copy- If no changes, submit copy of last page (signed/dated) Copy of Current Liability Insurance Infection Control Plan- if any updates submit a copy- If no changes, submit copy of last page (signed/dated) Poster of Residents Copy of current Administrator Certificate There were no deficiencies cited during today's inspection. Exit interview was conducted with Administrator David Hanna.the state’s words, verbatim · CDSS document, Jul 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Alviso, conducted a Required - 1 Year Inspection, on 6/17/25 at approximately and met with Administrator David Hanna, and Resident Care Coordinator (RCC) Karrie Hanna. Currently twenty-four (24) residents in care, and three (3) resident on Hospice. Facility specializes in dementia care. Hospice care waiver approved for eight (8) residents. Facility has a required infection control plan. Facility has a required emergency disaster plan. LPA toured the facility with the Administrator. The LPA will continue the annual inspection at a later date.the state’s words, verbatim · CDSS document, Jun 17, 2025

Allegation investigated: Licensee/facility staff failed to meet resident's care need

Licensing Program Analyst (LPA) Alviso, conducted a complaint inspection, approximately 11:20am on 1/9/25, and met with Resident Care Coordinator(RCC) Karrie Hanna. Administrator David Hanna arrived to the facility within 30 minutes after the LPA's arrival. The LPA reviewed resident records, medical documentation, and interviewed staff, and other related parties. Reporting party alleges that "Licensee/facility staff failed to meet resident's care needs". The investigation revealed that there are hydration times the facility provides hydration drinks, water/flavored water/tea/coffee, and other hydration fluids to residents in care; Per interviews with staff, S1, S2, S3, and S4, there are in-between mealtimes that staff offer drinks to the residents in care, as well as when the resident requests a drink and/or duriing resident mealtimes. Staff, S2, stated that the residents are encouraged to drink their water because a lot of the residents don't drink water/drink fluids on their own. Staff are to remind residents to drink their water and to offer drinks to the resident to help ensure hydration of the residents in care. Staff deny that they refuse to provide water to residents, and are rushing residents during mealtimes so residents that are taking longer can't eat. Per LPA's interviews with other related parties, 1, 2, and 3, in summary, they have not observed that staff don't provide water to the residents, and have observed staff giving water, tea, and coffee to residents; No staff observed rushing residents so they don't have the time to eat their food. Continued on LIC9099C... Unsubstantiated The Department didn't receive a suspected abuse report filed by a medical professional, Physician/hospital treating R1 that reports and states suspected neglect of the resident by facility staff/licensee that caused resident's dehydration. Per investigation and review of records, including medical records, there was no information obtained to support that violations had occurred regarding the allegation reported. Based on the interviews, record/document reviews, and related information obtained during the investigation, the allegation "Licensee/facility staff failed to meet resident's care needs” is Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies cited. Exit interview was conducted with the Administrator David Hanna.the state’s words, verbatim · CDSS document, Jan 9, 2025 · control 21-AS-20241029100037

Allegation investigated: Facility is not providing hygiene items/paper towels for residents use Violation of residents personal rights

Licensing Program Analyst (LPA) Alviso, conducted a complaint inspection, approximately 10:00am on 11/5/24, and met with Resident Care Coordinator(RCC) Karrie Hanna. RCC contacted the Administrator, David Hanna, who arrived after LPA's tour of the facility. LPA toured the facility with RCC Karrie Hanna; The facility does have a sufficient supply of hygiene products for all residents in care, including sufficient supply of paper towels, toilet paper, and linens. LPA discussed with RCC regarding linens and that regulation states, "The use of common wash cloths and towels shall be prohibited." RCC stated their understanding of this to the LPA. RCC stated the bathrooms have paper towel dispensers.The LPA observed that there are eight (8) bathrooms in the facility for residents in care.There are four (4) bathrooms that can be used by all residents in care, and the other four (4) are jack and jill bathrooms for the specific residents who reside in the connected rooms. LPA observed that the paper towels were not available in seven out of eight resident bathrooms. Bathrooms had toilet paper available.There is soap and sanitizer dispensers available for resident use. LPA discussed with the RCC Karrie, and Administrator David, that the paper towels for residents use must be available in every resident bathroom at all times. Continued on LIC9099C... Substantiated RCC had the staff filling the paper towel dispensers. Administrator stated that the dispensers that were not operational would be repaired and/or replaced. Administrator stated that all bathrooms would have a supply of paper towels for residents use at all times. Per LPA's observations and interviews with staff, there is sufficient information obtained to support a violation did occur, the allegation of "facility is not providing hygiene items/paper towels for residents use" is Substantiated. This deficiency will be cited, 87307(a)(3) Personal Accommodations and Services- The following provisions shall apply: Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident, the licensee shall assure provision of: Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The use of common wash cloths and towels shall be prohibited, see LIC9099D. LPA observed R1 in the facility, reviewed R1's records, and obtained information from interviewed staff and other related parties. Per investigation, R1 has a seat belt attached to their wheelchair that is used to keep resident in their chair; LPA observed that the seat belt goes straight across as a regular seat belt, which is not providing any postural support for the resident. Per interview with S2, the seat belt helps R1 from standing up and down when agitated, and from possible falls when leaning forward; S2 stated it keeps the resident in their chair. R1 is not able to unbuckle the seat belt on their own. LPA discussed personal rights of the resident/residents per regulation, and ensuring sufficient staff as needed. Administrator and S2 stated their understanding of the regulation. A clip alarm or similar item will be used and R1's care plan will be updated, per Administrator. Per LPA's observations and interviews with staff, there is sufficient information obtained to support a violation did occur, the allegation of "violation of resident's personal rights" is Substantiated. This deficiency will be cited, 87468.2(a)(4)Additional Personal Rights of Residents in Privately Operated Facilities-In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs, see LIC9099D. The preponderance of evidence standard has been met, therefore the allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited. Failure to correct deficiencies by due dates, may result in additional deficiency citations and/or civil penalties being assessed. Exit interview conducted with the Resident Care Coordinator, Karrie Hanna. Appeal Rights provided.the state’s words, verbatim · CDSS document, Nov 5, 2024 · control 21-AS-20241104104137

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Nov 6, 2024

87468.2(a)(4)Additional Personal Rights of Residents in Privately Operated Facilities-In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.This requirement was not met as evidenced by: Per investigation, R1 has a seat belt attached to their wheelchair that is used to keep resident in their chair; LPA observed that the seat belt goes straight across as a regular seat belt, which is not providing any postural support for the resident. Per interview with S2, the seat belt helps R1 from standing up and down when agitated, and from possible falls when leaning forward; S2 stated it keeps the resident in their chair. R1 is not able to unbuckle the seat belt on their own. This is a risk to resident's personal rights and to health & safety of resident.the state’s words, verbatim · CDSS document, Nov 5, 2024

Plan of correction: Licensee/Administrator to ensure the seat belt is removed from R1's wheelchair; Reassess the resident, and update the care plan as needed to meet resident's current care needs. Submit proof of correction, by photo for seat belt removal, and a plan to reassess the resident, and update care plan in a timely manner, no later than 11/13 . POC due 11/06/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(3) · Plan of correction due date: Nov 18, 2024

87307(a)(3) Personal Accommodations and Services- The following provisions shall apply:. Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident, the licensee shall assure provision of: Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The use of common wash cloths and towels shall be prohibited. This requirement was not met as evidenced by: Per Investigation, LPA observed that there are eight (8) bathrooms in the facility for residents in care. There are four (4) bathrooms that can be used by all residents in care, and the other four (4) are jack and jilll bathrooms for the specific residents who reside in the connected rooms. LPA observed that the paper towels were not available in seven out of eight resident bathrooms. This is a risk to residents personal rights and to the health & safety of residents in care.the state’s words, verbatim · CDSS document, Nov 5, 2024

Plan of correction: Licensee/Administrator to ensure that all bathrooms have paper towels available at all times, ensuring that all paper towel dispensers work. Ensure all bathrooms have a sufficient supply of hygiene items as needed for resident use, and that staff assist residents using bathrooms as needed. POC due 11/18/24.

Allegation investigated: Staff mismanaged resident’s medication

Licensing Program Analyst (LPA) Alviso, conducted a complaint inspection, approximately 9:30am on 10/9/24, and met with Resident Care Coordinator(RCC) Karrie Hanna. Administrator David Hanna arrived to meet with the LPA. LPA reviewed resident's (R1) records, including medical documentation, conducted interviews with staff, and other related parties. The investgation revealed that R1 has a care plan in place, and all medications prescribed by the Physician, were on-site, and inaccessible to all others that don't handle the medications. All R1's medications have Dr's Orders, per review of records. There was information and/or provided records that showed a mismanagement of R1's medications. Per interviews with staff, S1 & S2, all of R1's medications are provided as directed by the Physician, per the dosage instructions. There was conflicting information obtained regarding reported allegation of "Staff mismanaged resident’s medication". There was no information obtained that supported a violation had occurred regarding the allegation. Based on the interviews, record reviews, including medical documentation, and Observations, there was no information obtained that supported the above violation had occurred. The allegation is Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Nothe state’s words, verbatim · CDSS document, Oct 9, 2024 · control 21-AS-20240531164055

Allegation investigated: Staff do not ensure that resident is fed a healthy diet

Licensing Program Analyst (LPA) Alviso, conducted a complaint inspection, approximately 9:30am on 10/9/24, and met with Resident Care Coordinator(RCC) Karrie Hanna. Administrator David Hanna arrived to meet with the LPA. LPA reviewed resident's (R1) records, including medical documentation, conducted interviews with staff, and other related parties. The investgation revealed that R1 has a care plan in place, and all medications prescribed by the Physician, were on-site, and inaccessible to all others that don't handle the medications. Per interviews with S1 and S2, there is tons of facility food in large walk-in refrigerator, and freezer.S1 stated they are shopping in bulk all the time during the week as needed, and for all good sales that are available. S1 stated they keep a large food supply of non-perishables, and a very good variety of both perishable and non-perishable food items. LPA observed the food supply, and it was sufficient of a variety of food and drinks. There is also a food overflow storage shed with canned and boxed items that are used. All food items are used for the facility meals, per staff interviews. LPA observed a resident mealtime, and all the residents were eating all their meal,some interacting with one another. There was conflicting information obtained regarding reported allegation of "Staff do not ensure that resident is fed a healthy diet ". There was no information obtained that supported a violation had occurred regarding the allegation. Based on the interviews, record reviews, including medical documentation, and Observations, there was no information obtained that supported the above violation had occurred. The allegation is Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Nothe state’s words, verbatim · CDSS document, Oct 9, 2024 · control 21-AS-20240604104925

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Alviso, conducted a Required - 1 Year Inspection, and met with Administrator David Hanna and Resident Care Coordinator (RCC) Karrie Hanna. Currently twenty-four (24) residents in care, and one (1) resident on Hospice. Facility specializes in dementia care. Hospice care waiver approved for eight (8) residents. Facility has a required infection control plan, which is part of the plan of operation. Facility has a required emergency disaster plan. LPA reviewed six (6) resident files. All files were complete. LPA reviewed six (6) staff files. All staff had criminal record clearance as required. All staff had first aid, and cpr certification as required. Staff had required training. Fire clearance approval is for twenty-eight (28) non-ambulatory. All exits were cleared and free of obstruction. Fire extinguishers (5) are currently serviced and tagged as required. Sufficient food supply. Sufficient cleaner/disinfectants, personal protective equipment (PPE), paper products, furnishings, and linens. Sufficient lighting in hallways, bathrooms, resident rooms, and common areas. All postings were up and visible. Medications were locked up and inaccessible to residents in care. All cleaners/disinfectants were locked up and inaccessible to residents in care. LPA is requesting the following documents be updated and submitted by 7/27/24. LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610-Emergency Disaster Plan- if any updates submit copy- please ensure to date and sign last page Copy of Current Liability Insurance Infection Control Plan- if any updates submit copy- please ensure to date and sign last page No deficiencies cited today. Exit interview conducted with the Administrator.the state’s words, verbatim · CDSS document, Jun 27, 2024