Dale Commons

We haven’t transcribed this report yet. The complete document is on the state’s site.

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 09/21/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Patricia Holguin, who was briefly interviewed at this time. It was learned that there were (7) residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (15) residents at any given time. It was learned that there were (7) residents diagnosed with dementia at this time. This facility does have an approved program to be able to accept and retain residents diagnosed with dementia at any given time. This facility does not have a dedicated memory care unit on site at this time. Current census was 91 residents. Tour of the facility was conducted. A tour of the facility kitchen area was conducted. Food storage units, refrigerators and freezers, were toured. It was observed that there was a sufficient supply of 2-day perishable food quantities available on site to meet the requirements at this time. Pantry area was toured. It was observed that there was a sufficient supply of 7-day nonperishable food quantities available on site to meet the requirements at this time. A sample review was conducted for the facility resident bedrooms at this time. It was observed that furniture and furnishings were observed to be functional and maintained in compliance at this time. A sample review was conducted for the facility resident restrooms at this time. Hot water temperatures were taken to make sure that they measured within the allowed range of 105-120 degrees at all times. Grab bars and non skid surfaces were observed to be present and maintained in compliance at this time. Living areas, dining areas, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Laundry rooms were toured. They were observed to be made available to the facility residents who chose to perform their own laundry without the presence of laundry detergents, bleach, and supplies at this time. Rooms designated as supply rooms, storage rooms, and equipment rooms were observed to be locked and made inaccessible to the residents at this time. Medication carts were reviewed alongside the facility designated Administrator and present medication technician. Policies and procedures in regards to the handling, dispensing, and documentation of the resident medications were discussed at this time. This facility utilized mobile medication carts that were pushed out into the facility when it was time to dispense the medications to the residents. It was learned that this facility employed an E-MAR system as well as documented paperwork for the facility resident medications at this time. First aid kits, located in the medication carts, were observed to contain all of the required components at this time. Fire extinguishers, located throughout this facility, were observed to have been annually inspected by the local fire extinguisher company, Jorgensen Co., on 03/27/2026 and found to be in compliance at this time. A tour of the facility exterior grounds was conducted. A review of the perimeter fence, side gates, and all other exits was conducted at this time. A review of (10) facility resident files was conducted and noted on the following LIC 858. A review of (10) facility personnel files was conducted and noted on the following LIC 859. The following forms and documents were requested by this LPA to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Sep 21, 2026

Allegation investigated: Staff does not ensure residents call service lights are answered in a timely manner. Licensee does not provide sufficient staffing resulting in residents being left in soiled clothing for extended periods of time.

On 10/30/2025, Licensing Program Analyst (LPA) Triel Ellen Lindstrom made an unannounced visit to the facility to deliver findings on this complaint. The LPA met with the Operations Specialist and explained the purpose of the visit. Allegation: Staff does not ensure residents call service lights are answered in a timely manner. LPA Lindstrom reviewed the call button log for the week of July 1 – July 7, 2025. This log contained 2,871 calls. LPA Lindstrom conducted an in-depth analysis of a subset of this data. Of the 347 consecutive calls that were analyzed, staff responded to 285 calls in less than six minutes, 47 calls in six to ten minutes, and 15 calls in eleven plus minutes. Staff responded to call buttons in ten minutes or less 95.68% of the time, and staff responded to call buttons in five minutes or less 86.45% of the time. Unsubstantiated Based on a record review, the above allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. As a result of this investigation, no deficiencies were cited. The facility was in compliance with California Code of Regulations (CCR), Title 22, Division 6. An exit interview was conducted and copy of this report was provided to the Operations Specialist. Allegation: Licensee does not provide sufficient staffing resulting in residents being left in soiled clothing for extended periods of time LPA Lindstrom conducted staff interviews. Three staff (S1, S2, and S4) stated that there were no issues with providing incontinence care. LPA Lindstrom conducted three resident interviews. R1 stated that they did not experience inadequate incontinence care due to insufficient staffing or for any reason. R2 stated that they required a two-person assist, and that sometimes when a staff member calls out on the NOC shift, there is a delayed response to their call button. R2 is on a diuretic and sometimes urinates immediately after pressing the call button for assistance to go to the toilet because of the medication. LPA Lindstrom reviewed the call button response log and determined that over a two-day period (July 1- 2, 2025), staff responded to fifteen of R2’s twenty call buttons in five minutes or less, and nineteen of R2’s twenty call buttons in ten minutes or less. R3 stated that staff responded to their call buttons in a timely manner and provided adequate incontinence care. R3 stated that care staff do a great job. Based on interviews and record review, the above allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. As a result of this investigation, no deficiencies were cited. The facility was in compliance with California Code of Regulations (CCR), Title 22, Division 6. An exit interview was conducted and copy of this report was provided to the Operations Specialist.the state’s words, verbatim · CDSS document, Oct 30, 2025 · control 27-AS-20250703143958

Type of visit: Required - 1 Year

On 07/09/2025, Licensing Program Analyst (LPA) Triel Ellen Lindstrom arrived unannounced at the facility to conduct a required annual inspection. The LPA met with Designated Facility Administrator (DFA) Larry Potter. The LPA introduced herself, explained the purpose of the visit, and conducted an interview with the Administrator. The DFA accompanied the LPA on a tour of the facility. The facility is a two-story building that is licensed for one hundred and ten residents. The facility has a hospice waiver for fifteen. The census was eighty-eight at the time of this inspection. The facility was remodeled in 2024, including new flooring, paint, and furniture throughout the common areas of the facility. In addition, the upstairs activity area was outfitted with a large screen television and theater chairs, and the staff room was expanded and a kitchenette was added to it. The DFA began the inspection tour on the first floor in the large dining room located just inside the entry way. The room was carpeted and contained many tables and padded chairs. The room has a high ceiling and is lit by hanging light fixtures and natural light from windows. The LPA observed lunch being served between 11 AM and 1 PM. Service was restaurant style –staff takes residents’ orders at the table and food is delivered to the tables. There is a small adjacent private dining area separated from the main room by windows and a door with glass panes, which can be reserved by residents for private events. The LPA then toured the bistro, a small room near the dining area that has a small food service station and several tables. The dining room and bistro are both used for activities, including bingo, jeopardy, exercise classes, and word games. This report continues on page 2. The LPA observed the front entry desk, a section of which had been lowered during last year’s remodel to be more ADA accessible. Beyond this is a small front room with living room furniture, including couches and chairs, which residents can use to visit, rest, and watch television. Also on the first floor, the LPA toured a small, locked medicine room, which is used for the storage of overflow, incoming, and refrigerated medications. This room also contained a large first aid kit and a go-bag with first aid supplies. The LPA observed two laundry rooms on the first floor that are for use by residents who do their own laundry. There is also a fitness center and a commercial laundry on the first floor. While touring the hallways, the LPA observed multiple fire extinguishers, smoke detectors, and a sprinkler system, all of which were serviced by Jorgensen Company of Modesto on June 18, 2025. The facility used Universal Fire to monitor its alarms and notify the fire department. The DFA stated that the facility does disaster drills once a month for all three shifts, including for fire and earthquakes. The LPA observed two medication carts located downstairs in hallways. The medication carts contained resident medication. The carts locked and unlocked with a keypad, and drawers automatically lock when closed. The LPA interviewed a Med Tech and reviewed the facility’s electronic medication administration record and paperbased logs, and determined that medications and documentation were in compliance. The LPA toured the kitchen. The floors, walls, equipment, shelves, and appliances were clean. The hood was last serviced in April 2025 by Certified Kitchen Exhaust Cleaner. The LPA observed a food supply that was adequate for 2-day perishable and 7-day nonperishable in the refrigerators, freezer, and dry storage pantry. The LPA toured the upstairs of the facility. There are four staircases and one elevator between floors. The LPA observed evacuation chairs in the stairways and a certificate in the elevator from its last service on 11/25/2024. The LPA toured the beauty salon, activity area with its new seating and television, and a library with a sitting area, computer desks and a water station. The LPA observed two more med carts in the hallways and two more resident laundry rooms. The LPA observed three resident bedrooms. The bedrooms are clean, pest and odor-free, and have the required furniture. The LPA measured hot water in a resident sink at 124 degrees Fahrenheit, which is outside of the required temperature range of 85 to 120 degrees. The DFA corrected this during the visit. This report continues on page 3. The LPA toured the grounds, which consist of manicured grass lawns and ornamental bushes. The concrete walkways are free of obstructions. The backyard, accessed through the bistro, contained shade structures and seating for residents. There were also raised beds and a putting green. The LPA reviewed seven resident files and nine client files. All files were in compliance. The entire facility clean, odor and pest free, and had the required furniture. The LPA observed residents engaged in activities and socializing over meals. The LPA requested that updated copies of these documents be submitted to her by 5:00 PM on 7/28/2025. (1) LIC 308 Designation of Facility Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Emergency Disaster Plan (5) Proof of Liability Insurance (6) LIC 500 Personnel Report (7) LIC 309 Administrative Organization As a result of this inspection, the facility was not in compliance with California Code of Regulations (CCR), Title 22, Division 6. A deficiency was cited. The DFA corrected the deficiency during the site inspection by adjusting the water heaters. Please see the LIC 809D report for citations related to the deficiency observed during the inspection. An exit interview was conducted with the DFA, to whom copies of this LIC809 report, the LIC 809D, and the appeals rights were provided. Their signature below confirms receipt of this document.the state’s words, verbatim · CDSS document, Jul 10, 2025

Allegation investigated: Staff are not safeguarding resident personal items

On 7/3/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to open a complaint investigation in to the above listed allegation. LPA Jensen met with Executive Director (ED) Larry Potter and Business Office Manager Christine Mancuso and explained the purpose of today's visit. During the course of the visit, LPA Jensen interviewed 3 staff members, 2 residents and 1 resident family member. LPA Jensen also reviewed 1 resident file. All staff members interviewed confirmed the laundry policy consists of each resident having a designated laundry day. On the designated laundry day during the day shift, a specific staff member collects the laundry and places it in a mesh bag that contains only one resident's clothing. That bag is tagged and washed in a commerical machine and laundry is returned to the resident's room, typically same day. In the evenings care staff will launder clothing or bedding if there is no fresh change of clothing or fresh linen available. If there is alternative clothing options or bedding the laundry can be bagged and tagged and left by the laundry room for the day staff to clean. Unfounded The residents interviewed confirmed the laundry routine to be as stated by staff. During the course of an interview Resident 1 (R1) , he stated that personal clothing items have gone missing. LPA Jensen interviewed the responsible party for R1 who confirmed that sometimes she brings R1's clothing home, launders it and returns it. Staff 1 and staff 2 also confirmed that some minor interventions surrounding laundry service have been implemented in collaboration with the family to provide a safe environment for R1. All staff and residents gave consistent information regarding the facility policy and procedures for resident laundry service. The laundry service protocol includes measures to keep resident clothing separate and accounted for. Based on staff interviews and an interview with R1's responsible party, R1's clothing is brought home on occasion and brought back at a later date. The resident file record review reveals that R1 could have potential for memory lapse. As a result of the interviews conducted and records reviewed the allegation of "Staff are not safeguarding resident personal items" is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened, or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 3, 2024 · control 27-AS-20240625151010

Type of visit: Required - 1 Year

On 6/25/24 at approximately 9:50am Licensing Program Analysts (LPAs) Maja Jensen and Kesha Lewis arrived at facility unannounced to conduct a required 1 year annual visit. LPAs Jensen and Lewis met with Executive Director Larry Potter and explained the purpose of today's visit. LPA Jensen and Lewis toured the facility grounds. All paths were free of obstruction. The grounds were observed to be well maintained. There is a large fountain at the front entrance but no bodies of water on the property. All window screens were in observed to be in good repair. There is outdoor furniture available client and guest use. LPA Jensen toured the physical plant interior. The facility was observed to be sanitary and free of odor. All furniture was in good repair. The thermostat was set at 77 degrees Fahrenheit which falls within the required range of 68 - 85 degrees. The bathroom water temperature was measured at 112 degrees Fahrenheit which falls within the required range of 105 - 120 degrees Fahrenheit. The individual bedroom units contained all required furniture. The individual units have bathroom vanities with locks so that individuals can lock medication if they are able to self administer. The smoke detectors and carbon monoxide detectors were tested and found to be in good working order. The fire extinguisher was last serviced in June of 2024 and is in compliance. The Ansul system which requires semi-annual service was last serviced in April of 2024 and is in compliance. The emergency disaster plan was reviewed and determined to be current and appropriate. LPA Jensen and Lewis observed lunch service during the course of the visit. The menu listed for the day accurately reflected the meal served. LPA Jensen inspected the kitchen and observed it to be sanitary. There was a 2 day supply of perishable food and a 7 day supply of non-perishable food. All food removed from original packaging was labeled with expiration dates. The refrigerators and freezer were maintained at the appropriate temperature and were sanitary. There are charts in the dining room with resident photos and food restrictions or dietary preferences listed. There are a variety of activities available for client engagement. The facility employs a fitness director as well as an activity director and an activity assistant. A total of 7 activities were scheduled for the day including garden club, head to toe stretching, and wheel of fortune. There are large monitors in the common area of the facility that display the activities with times, meal service information and other pertinent information for residents. The same information displayed on the large monitors is available on the TV in the individual bedrooms or on paper. The facility also has a gym, a beauty salon, reading rooms, and a laundry room for resident use. No toxins or medications were observed to be accessible to residents in care. LPA Jensen and Lewis reviewed 10 staff files and 10 resident files. All files were determined to be complete and in compliance. LPA Jensen interviewed 5 residents and 5 staff members. All residents stated they are satisfied with all aspects of care. All staff members interviewed were adequately able to answer the questions asked. LPA Jensen obtained a current LIC 500 and resident roster. LPAs Jensen and Lewis left the facility for a meal break period between the hours of 11am and 12pm. The facility was determined to be in substantial compliance. No deficiencies were noted during the course of this inspection. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 25, 2024