Marbella Visalia

Type of visit: Case Management - Deficiencies

On 08/07/2026, Licensing Program Analyst (LPA) Kaur arrived unannounced regarding an inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Executive Director J. Pablo Blas. The purpose of today’s inspection is to issue a deficiency that was found during the investigation of complaint # 24-AS-20260731085335. During the investigation tour of the facility, it was found that a cleaning cart was left unlocked in the facility hallway with chemicals accessible to residents. A deficiency is being issued in accordance with California Code of Regulations, Title 22, Division 6 on the attached 809D Exit interview conducted and a plan of correction was reviewed and developed with Executive Director Pablo Blas. A copy of this report and appeal rights were discussed and provided to Executive Director Pablo Blas whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Aug 7, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Aug 8, 2026

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above LPA observed cleaning cart was left unlocked in the facility hallway with chemicals/ cleaning supplies accessible to residents.the state’s words, verbatim · CDSS document, Aug 7, 2026

Plan of correction: Licensee / Administrator agrees to submit a statement of intent by due date to complete an in-service training with all staff regarding keeping disinfectants, cleaning solutions unaccusable to residents and submit records when completed

Type of visit: Case Management - Incident

On 8/07/2026, Licensing Program Analyst (LPA) K.Kaur conducted an unannounced Case Management visit. LPA introduced self and explained reason for visit to Executive Director J. Pablo Blas LPA arrived at the facility to conduct case management visit for incident report CCLD received on 6/02/026 regarding an incident dated 06/1/2026 for R1 for a open wound. LPA conducted interviews and reviewed documents. Based on record review facility had a medical assessment conducted on 6/3/2026 with doctor for the stage 2 wound. Home health handles care for the wound. No deficiencies sited during this Case Management visit. An exit interview was conducted with Executive Director Pablo Blas. A copy of this report was discussed and provided to Executive Director, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Aug 7, 2026

Allegation investigated: Staff did not administer residents medication in a timely manner. Staff do not keep an accurate medication log.

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for initial 10-day complaint inspection. Administrator was unavailable to meet. LPA met with Resident Care Director Brittney Polman and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. Based on observations, interviews conducted and records reviewed, the facility med-cart keys were locked in the cart on 03/2/2026 in error. Staff did not administer residents’ medication in a timely manner. The facility was unable to open the med-cart until 3/3/2026 6 AM. Residents R1 – R6 did not get 3/2/26 night medications. During Medication review facility discovered Staff were not keeping a log of medications in the Centrally Stored Medication and Destruction Record. The preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. See citations on the attached LIC9099D. Repeat Civil penalties assessed. Exit interview was conducted with Resident Care Director and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Mar 6, 2026 · control 24-AS-20260303131432

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Mar 7, 2026

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 is not met as evidenced by: Based on observation, interview, and record, facility did not comply with the regulations listed above, which poses an immediate health and safety risk to residents in care. R1 – R6 did not receive their medications the evening of 3/2/26.the state’s words, verbatim · CDSS document, Mar 6, 2026

Plan of correction: Facility has made the following corrections: Facility has removed med-tech to caregiver duties. Facility has received 3 key copies from Pharmacy. Facility has implemented rules to ensure keys are not misplaced in the future. Licensee agrees to submit a statement of intent regarding training by due date. Licensee will conduct medication training with all Med-Tech staff and submit documentation of training when completed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(6) · Plan of correction due date: Mar 9, 2026

87465(h)(6) - Incidental Medical and Dental Care: (h)The following requirements shall apply to medications which are centrally stored: (6)The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes… This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, facility had an issues receiving Centrally Stored Medication records from Pharmacy. Facility staff were supposed to log medications on Centrally Stored Medication and Destruction log and failed to do so.the state’s words, verbatim · CDSS document, Mar 6, 2026

Plan of correction: Licensee agrees to submit a statement of intent regarding training by due date. Licensee will conduct medication training with all Med-Tech staff and submit documentation of training when completed.

Allegation investigated: Resident sustained a fall due to licensee neglect.

On February 12, 2026 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to deliver findings for a complaint the Dept received for the allegations listed above. LPA met with Interim Administrator Vivian Villegas. Regarding the allegation: Resident sustained a fall due to licensee neglect. LPA conducted interviews with staff and residents. During the interviews no comments were made stating or indicating the resident's had fallen due to neglect. 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, therefore the allegation is unsubstantiated. Exit interview was conducted and a copy of this report was provided to Interim Administrator Vivian Villegas. Unsubstantiatedthe state’s words, verbatim · CDSS document, Feb 12, 2026 · control 24-AS-20251120143046

Allegation investigated: Staff are mismanaging resident's medications. Staff are not following resident's care plan as required. Staff are not following reporting requirements as required.

On February 12, 2026 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct interviews and deliver findings for the allegations listed above. LPA met Interim Administrator- Vivian Villegas. Regarding the allegation: Staff are mismanaging resident's medications. LPA reviewed R1 and R2's medications. R2 was not assisted with medication as needed/prescribed. LPA observed the following: R2’s medication Ropinirole HCL1 MG Tablet- Take 1 tablet by mouth at bedtime. This medication is showing with a start date of 1/15/2026, the bubble pack holds 30 pills with 5 pills still in the bubble pack. LPA reviewed MARs which did not indicate the medication was missed or refused by the resident. The MARs shows this medication has been taken every night as prescribed, at 8:00 PM from January 15, 2026 thru February 11, 2026. R2 has too many pills left in the bubble pack, which indicates medication was missed or not given on three different occasions. Substantiated R2’s medication Diclofenac SOD DR 50MG Tab. LPA observed a bubble pack labeled as morning and was observed to have the correct amount was dispensed, the evening bubble pack shows with a start date of 1/15/2026, the bubble pack holds 30 pill, there are three pills left which indicates on one occasion R2 missed or refused their medication, the MARS does not indicate pill missed or refused. Based on interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Regarding the allegation: Staff are not following resident's care plan as required. LPA reviewed R3 and R4's files which did not have a Home Health Care Plan which indicates there is no plan to follow. Based on interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Regarding the allegation: Staff are not following reporting requirements as required. Interviews were conducted with staff and residents. R1 had fallen in November 2025 and a report was not sent to the Dept. Based on records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. TSP offered and accepted. Deficiencies were cited under Title 22. Exit interview was conducted and copy of this report LIC9099, LIC9099D, and appeal rights were provided to Interim Administrator- Vivian Villegas.the state’s words, verbatim · CDSS document, Feb 12, 2026 · control 24-AS-20251120143046

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Feb 13, 2026

87465 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 is not met as evidenced by: Based on observation, interview, and record, facility did not comply with the regulation listed above, which poses an immediate health and safety risk to residents in care. R2 was not assisted with medication as needed/prescribed. R2’s medication Ropinirole HCL1 MG Tablet- Take 1 tablet by mouth at bedtime. This medication is showing with a start date of 1/15/2026, the bubble pack holds 30 pills, there are still 5 pills left in the bubble pack. LPA reviewed MARs which did not indicate the medication was missed or refused by the resident. The MARs shows this medication has been taken every night as prescribed, at 8:00 PM from January 15, 2026 thru February 11, 2026. R2 has too many pills left in the bubble pack, which indicates medication was missed or not given on three different occasions.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: Facility provided current training verification of MedTech staff.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87609(b)(4)(A-C) · Plan of correction due date: Feb 19, 2026

87609 Allowable Health Conditions and the Use of Home Health Agencies (b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident’s medical condition(s). (A) The written agreement shall reflect the services, frequency and duration of care. (B) The written agreement shall include day and evening contact information for the home health agency, and the method of communication between the agency and the facility, which may include verbal contact, electronic mail, or logbook. (C) The written agreement shall be signed by the licensee or licensee representative, and representative of the home health agency, and placed in the resident’s file. This requirement is not met as evidenced by: Based on observation, interview, and record, facility did not comply with the regulation listed above, which poses a potential health and safety risk to residents in care. LPA reviewed R3 & R4's files which did not have a Home Health Care Plan. The plans cannot be followed if there is no home health care plan on file.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: Licensee was able to obtain copy of current Home Health Care Plan and will obtain plans for future residents.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Feb 19, 2026

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. Based on observation, interview, and record, facility did not comply with the regulation listed above, which poses a potential health and safety risk to residents in care. LPA reviewed R1's incident reports which did not indicate R1's fall was reported to the Dept.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: Licensee will send a statement regarding steps taking to ensure reports are sent out. verification will be sent to the Dept by POC date.

Allegation investigated: Staff is disclosing personal information regarding the residents Staff is not properly reporting incidents involving the residents

On 12/30/25 at 9:00 am Licensing Program Analyst (LPA) J. Leffall conducted an initial complaint visit to open and to deliver findings on above allegations. LPA met with Resident Care Director (RCD) Britney Polman. The Department conducted an interviews with facility staff. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. No deficiencies were issued. Exit interview conducted. A copy of this report was distributed to Resident Care Director which confirms signature of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 30, 2025 · control 24-AS-20251217153636

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Dec 31, 2025

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. Based on records reviewed and interviews conducted, R1’s medication count is not accurate and medication administered does not match the MARS, which poses an immediate Health & Safety risk to the residents.the state’s words, verbatim · CDSS document, Dec 30, 2025

Plan of correction: Licensee agrees that all Med-Tech staff complete medication training. Licensee agees to submit completion documents to CCLD by POC due date.

Allegation investigated: Resident sustained an injury while in care.

Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. During the course of this investigation LPA reviewed facility files relevant to the complaint investigation. It was determined that the above allegation: Resident sustained an injury while in care is UNFOUNDED. The evidence from the investigation indicated that the resident did not sustained injury while in care. This agency has investigated the complaint alleging (Resident sustained an injury while in care). We have found that the complaint was unfounded, therefore we have dismissed the complaint. Unfoundedthe state’s words, verbatim · CDSS document, Dec 3, 2025 · control 24-AS-20251124130557

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Dec 19, 2025

87211(a)(1) Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. LPA observed during an investigation that an indicent was not reported to Community Care Licensing.the state’s words, verbatim · CDSS document, Dec 3, 2025

Plan of correction: Per Interim Executive Director/Administrator, an inservice training will be conducted by the POC date.

Allegation investigated: Staff are not keeping resident information/records confidential

On 12/02/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct complaint visit to deliver complaint findings on the above allegation. LPA introduced self, stated the purpose of the visit and met with Resident Care Director Brittney Polman. During the course of the investigation, facility was toured and interviews were conducted. Based on interviews conducted, residents’ information is provided to outside medi-cal assisted agencies programs for referral to verify if the resident meets the programs requirements prior to the resident applying for the medi-cal assisted programs without resident’s knowledge. Residents are unaware of the programs until the outside agencies meet with the residents after the referral has been accepted for the initial enrollment process. Therefore, the allegation alleging staff are not keeping resident information/records confidential, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Exit interview was conducted. A copy of this report and appeal rights was provided to Resident Care Director Brittney Polman, whose signature on this form confirms receipt of this report. Substantiatedthe state’s words, verbatim · CDSS document, Dec 2, 2025 · control 24-AS-20251116222344

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(c) · Plan of correction due date: Dec 8, 2025

87506 (c) All information and records obtained from or regarding residents shall be confidential. This requirement was not met as evidence by: Based on interviews conducted, residents’ information are provided to outside medi-cal assisted agencies programs for referral to verify if the resident meets programs requirement without resident’s knowledge, which poses/posed a potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 2, 2025

Plan of correction: Written Plan of Correction shall be submitted to the Fresno CCL by POC due date 12/08/25.

Allegation investigated: Staff are financially abusing residents

On 11/25/25 Licensing Program Analyst (LPA) M. Garza completed an unannounced visit to deliver complaint findings. Facility is currently without an Executive Director/Administrator effective 11/19/25. LPA met with Generations Program Director, Isabel Cervantes, explained reason for visit and was permitted entry into the facility. Residents observed in common areas. During investigation interviews were conducted with staff, residents, and responsible parties. Documentation (staff schedules, staff roster with contact information, calls of service, resident files for R1 R2, R3, R4 and R5, staff files for S1 and S2,special incident reports, safeguarding for cash and valuables, and bank statements) were reveiwed. Tours of the facility were conducted on 06/10/2025 and 10/25/25. During interviews it was disclosed mulitiple residents had money and items of value stolen from them. Interviews and records reviewed show that not all incidents were reported to the local law enforcement or Community Care Licensing. S1 has been terminated from the facility.the state’s words, verbatim · CDSS document, Nov 25, 2025 · control 24-AS-20250605163501

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Dec 12, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) 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: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met as evidence by: review of records and interviews conducted. The licensee did not comply with the section cited above in that multiple residents had money or items stolen from them at the facility. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 25, 2025

Plan of correction: Training will be completed with all staff on personal righst-financial exploitation. Training will include; what staff need to do when reported, what to fill out and who to notify. In-service sign in sheet and training material will be provided to CCL by POC date.

Type of visit: Case Management - Deficiencies

On 11/25/25 Licensing Program Analyst (LPA) M. Garza completed an unannounced case management visit. Facility is currently without an Executive Director/Administrator effective 11/19/25. LPA met with Generations Program Director, Isabel Cervantes, explained reason for visit and was permitted entry into the facility. Residents observed in common areas. This case management visit is being conducted due to issues found during complaint investigation for complaint #24-AS-20250605163501. During interviews it was disclosed multiple residents had money and items of value stolen from them. During record review it was observed that the facility is not completing the safeguarding valuables (LIC 621). Regulations for safeguarding are not being followed. Interviews and records reviewed show that all incidents of theft are not being reported to the appropriate agencies including Community Care Licensing, local law enforcement and or Long Term Care Ombudsman as required. Deficiencies cited on attached 809D per California Code of Regulations, Title 22. Exit interview completed with Generations Program Director, Isabel and Resident Care Coordinator, Brittany Polman. A plan of correction was developed by GPD and RCC and reviewed by LPA. A copy of this report, deficiencies and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 25, 2025

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.153(i) · Plan of correction due date: Dec 12, 2025

1569.153 Theft and loss program; standards, property inventories and surrender of personal effects; secured areas (i) Reports to the local law enforcement agency within 36 hours when the administrator of the facility has reason to believe resident property with a then current value of one hundred dollars ($100) or more has been stolen. Copies of those reports for the preceding 12 months shall be made available to the State Department of Social Services and law enforcement agencies. This requirement was not met as evidence by: record review. The licensee did not comply with the section cited above in that incidents of theft of $100 or more were not reported appropriately. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 25, 2025

Plan of correction: Training to be completed with all staff on theft and loss program standards, property inventories and surrendering personal effects. In-service sign in sheet and training material will be provided to CCL by POC date as proof of correction.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a) · Plan of correction due date: Dec 12, 2025

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:… This requirement was not met as evidence by: records reviewed. The licensee did not comply with the section cited above in that special incident report(s) were not submitted to Community Care Licensing as required. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 25, 2025

Plan of correction: Training will be completed with all staff on reporting requirements and mandated reporting. In-service sign in sheet and training material will be provided to CCL by POC date as proof of correction.

Allegation investigated: Staff did not provide resident with a refund

On 11/24/2025, Licensing Program Analyst (LPA) Gorban arrived unannounced to conduct an initial complaint investigation. LPA introduce self, stated the purpose of the visit, and met with resident services director Brittney Pullman. During the course of the investigation, interviews were conducted, and records were reviewed. Interview and records reviews revealed R1 monthly service fees $1395.00. In Septemebr this year resident was notified of new monthly service fees for the same service will be $1100.00 which does not start until January 1st of 2026. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, report signed and a copy of this report was provided to resident services director Brittney Polman for facility records. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 24, 2025 · control 24-AS-20251107111324

Type of visit: Case Management - Deficiencies

On 11/24/2025, Licensing Program Analyst (LPA) Gorban arrived unannounced conduct a Case Management deficiency visit. LPA introduce self, stated the purpose of the visit, and met with Resident Care Director Brittney Polman. The purpose of the today's visit is to address an incident where requested records were not provided for resident (R1) by due date, as recorded, by November 14th, 2025. A deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached LIC 809D. In addition, LPA requested facility file- designation of facility responsibility by 11/26/2025 An exit interview was conducted. A copy of this report and appeal rights were provided to Resident Care Director, whose signature confirmed receipt of this report.the state’s words, verbatim · CDSS document, Nov 24, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Nov 29, 2025

87506 Resident Records. (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not observed as evidenced by. The facility staff failed to keep at the facility and provide requested documents for R1 which were requested and agreed upon due date, of November 14th, 2025 which poses potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 24, 2025

Plan of correction: The facility staff will review and follow regulations regarding residents records. A plan with detailing steps the facility will take to ensure the requirements for Resident records are met will be submitted to the Fresno CCL by the POC due date 11/29/2025.

Type of visit: Case Management - Deficiencies

On 11/20/25, Licensing Program Analyst (LPA) Yang arrived unannounced conduct a Case Management deficiency visit. LPA introduce self, stated the purpose of the visit, and met with Resident Care Director Brittney Polman. The purpose of the today's visit is to address an incident where medications were found in the resident’s room after medication signed off by staff that medications were administered. Interviews were conducted, medications were checked, and records were received. R1’s evening medication Atorvastatin was founded in R1’s room the following day after the medication was signed off that it was administered. A deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached Lic 809D. An exit interview was conducted. A copy of this report and appeal rights were provided to Resident Care Director, whose signature confirmed receipt of report.the state’s words, verbatim · CDSS document, Nov 20, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(d)(4) · Plan of correction due date: Nov 21, 2025

87411(d)(4) Knowledge required to safely assist with prescribed medications which are self-administered. This requirement was not met as evidenced by: Based on observation, records reviewed, and interview conducted, R1 was given evening medication Atorvastatin and staff recorded that medication was administered. Atorvastatin medication tablet was found the following day. S1 did not ensure R1’s evening medication was administered as prescribed prior to recording that medication was administered, which poses/posed an immediate health and safety risk for the person in care.the state’s words, verbatim · CDSS document, Nov 20, 2025

Plan of correction: S1 received in-services training on medication on 11/04/25. Record of S1’s in-service training was received. POC cleared during visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Nov 24, 2025

87211(a)(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidenced by: Based on record review and interview conducted, a written report was not reported to the department within 7 days of incident when R1’s Atorvastatin medication tablet was found the following day after medication was recorded administered, this poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 20, 2025

Plan of correction: A plan detailing steps the facility will take to ensure the requirements for Reporting requirements are met will be submitted to the Fresno CCL by the POC due date 11/21/25.

Type of visit: Case Management - Other

On 11/4/25 Licensing Program Analyst (LPA) J. Leffall arrived unannounced for a case management visit regarding a Default Decision and Order for Staff 1 (S1). LPA met with Resident Care Director (RCD) Brittaney Polman. RCD verified Anthony Davis is not employed. LPA conducted visit to verify an individual that no longer has a criminal record clearance is working at the facility. LPA was informed by Administrator that Staff member is not employed at the facility and no longer associated with the facility. Exit interview was conducted. A copy of this report was provided to RCD, whose signature confirms receipt of this report.the state’s words, verbatim · CDSS document, Nov 4, 2025

Type of visit: Case Management - Other

On 10/25/2025 Licensing Program Analyst (LPA) M. Garza completed a case management visit. LPA met with Medical Technician, Kimberly Reyes explained reason for visit and was permitted entry into the facility. Resident Care Coordinator, Brittany Polman arrived some time later and stated the Executive Director, Mandy Rancour was unavailable. LPA completed a health and safety check on residents in care and toured the facility. Residents were observed in common areas and in rooms. This case management visit is being conducted for deficiencies observed during complaint visits conducted for complaint #24-AS-20250605163501 on 6/10/25 and 10/25/25. The following issues were observed: gate with lock to kitchenette preventing access to food/drink and posing a tripping hazard observed in memory care. Required postings are not posted in the facility. The complaint poster for RCFE facilities (PUB 475) was not posted. Incident reports reviewed disclosed R3 had an allergic reaction on 5/14/25 and R1 had medication in their room unlocked and accessible on 5/15/25 both posing hazards to residents in care. Deficiencies cited per California Code of Regulations, Title 22. If not corrected, deficiencies cited will pose a direct impact to residents in care. Exit interview completed with Resident Care Coordinator, Brittany Polman. A plan of correction was developed by Brittany and reviewed by LPA. A copy of this report, deficiencies and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 25, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468(c) · Plan of correction due date: Nov 7, 2025

87468 Personal Rights (c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. This requirement was not met as evidence by LPA observation. The licensee did not comply with the section cited above in that required postings are not posted in the facility. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2025

Plan of correction: RCD stated they will have posting placed up in the facility. RCD stated they will take pictures showing the posting were placed as proof of correction.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87468(c)(2)(A) · Plan of correction due date: Nov 7, 2025

87468 Personal Rights (c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20" x 26" in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. This requirement was not met as evidence by LPA observation. The licensee did not comply with the section cited above in that the RCFE complaint poster was not posted at the facility. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2025

Plan of correction: RCD stated they will have the RCFE complaint poster placed up. A picture will be sent to CCL as proof of correction by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(1) · Plan of correction due date: Nov 7, 2025

87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement was not met as evidence by residents file review. The licensee did not comply with the section cited above in that review of special incident reports disclosed R3 had an allergic reaction on 5/14/25 and R1 had medication in their room unlocked and accessible on 5/15/25. This poses a potential health safety and or personal right risk to residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2025

Plan of correction: RCD stated they will update the board in the kitchen to include type of diet, food texture type and allergies. An in-sevice will be completed with all kitchen staff and care staff. In-service sign in sheet and traiing material will be sent to CCL as proof of correction.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87468.1(a)(3) · Plan of correction due date: Nov 7, 2025

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidence by LPA observations on 6/10/25 and 10/25/25. The licensee did not comply with the section cited above in that a gate with lock to kitchenette preventing access to food/drink and posing a tripping hazard observed in memory care. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2025

Plan of correction: RCD stated that gate and lock will be removed by maintenence.RCD stated they will also have staff remove knobs/place a locking mechanism on stove when not in use. Pictures will be provided to CCL by POC date as proof of correction.

Allegation investigated: Staff are not providing adequate food service to residents in care.

On 10/13/25 at 9:30 am Licensing Program Analyst (LPA) J. Leffall conducted an initial complaint visit to open and to deliver findings on above allegations. LPA met with Administrator (A1) Mandy Rancour. The Department conducted an interviews with facility staff, reviewed facility records, and resident files food menu, food alternative menu and list of residents that contain food allergies.Per interview the facility is actively addressing and correcting concerns regarding issues and concerns residents have regarding the food during monthly food commitee meetings held every 10th day of the month. Persons attended are any residents who prefer to attend, the Administrator and Head Chef. LPA toured the kitchen and dining room areas. LPA observed the kitchen to be clean and food fresh and ready to serve. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. No deficiencies were issued. Exit interview conducted. A copy of this report was distributed to Administrator which confirms signature of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 13, 2025 · control 24-AS-20251007120512

Allegation investigated: Staff speaks inappropriately to resident

On 10/13/2025, Licensing Program Analyst (LPA) M Vega conducted an unannounced inspection at the facility and met with Administrator - Mandy Rancour. The purpose of the visit was to close a complaint investigation and deliver findings regarding the above allegation. It was alleged that the facility Staff speaks inappropriately to resident. (R1-R5 see attached confidential names list). Based on interviews and record review it has been determined that the facility does speak to residents in a respectful and appropriate manner and determined the allegation is unfounded. This agency has investigated the complaint alleging “Staff speaks inappropriately to resident .” We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened or is without a reasonable basis. We have found that the complaint was unfounded, therefore we have dismissed the complaint. Unfoundedthe state’s words, verbatim · CDSS document, Oct 13, 2025 · control 24-AS-20250808080935

Allegation investigated: Facility staff did not ensure to follow resident food restrictions. Facility staff are not providing adequate food service to residents.

On 10/02/2025, Licensing Program Analysts (LPAs) M. Medina and L. Salazar conducted an unannounced subsequent complaint visit. LPAs introduced themselves, stated purpose of visit and allowed entrance. LPAs met with Executive Director, Mandy Rancour. During the subsequent visit, LPAs conducted interview with Executive Director, toured kitchen, and obtained additional information. Based on LPA's observation and record review, there is not a preponderance of evidence to prove or disprove that the allegations occurred therefore the allegations are UNSUBSTANTIATED. No deficiencies issued during this complaint visit . Exit interview conducted. A copy of this report will be provided by email to Executive Director. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 2, 2025 · control 24-AS-20250619110641

Allegation investigated: Licensee did not refund resident's preadmission fee

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Resident Care Director Brittany Polman. LPA explained the purpose of the visit. Resident Care Director Brittany Polman contacted Administrator Mandy Rancour via telephone who gave permission for Resident Care Director Brittany Polman to assist with the visit. Based on interviews and records review, R1 left the facility on 7/3/25 and did not receive a refund within the contract agreement. Records review of admissions agreement states residents will receive refunds within 21 business days. Facility did not issue a check to R1 until 8/22/25. Based on interviews and records review, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. A deficiency is being cited on the attached 9099-D. A copy of this report with plans of corrections and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Sep 27, 2025 · control 24-AS-20250731084237

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(5)(A) · Plan of correction due date: Oct 3, 2025

87507 Admission Agreements (g) Admission agreements shall specify the following: (5) Refund conditions (A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned.... pursuant to Health and Safety Code section 1569.652. This requirement was not met as evidenced by: Licensee did not refund R1 timely. R1's admissions agreement states refunds will be issued within 21 business days. R1 moved out of facility on 7/3/25 and refund was not issued until 8/22/25 which poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 27, 2025

Plan of correction: Licensee agrees to submit in writing to LPA how this regulation will be met by POC due date 10/3/25

Allegation investigated: Staff are financially abusing residents Staff open resident's mail without resident's consent.

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Resident Care Director Brittany Polman. LPA explained the purpose of the visit. Resident Care Director Brittany Polman contacted Administrator Mandy Rancour via telephone who gave permission for Resident Care Director Brittany Polman to assist with the visit. LPA interviewed staff, residents and witnesses. LPA reviewed records. Based on interviews and records review, Facility staff cashed two checks that were delivered to the facility and were made out to R1. Both checks were depostied into the facility account. Based on interviews, S1 opened R1's mail that was addressed to R1 without permission. Substantiated Based on interviews and records review, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited on the attached 9099-D. A copy of this report with plans of corrections and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 27, 2025 · control 24-AS-20250815082249

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Sep 29, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) 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: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met as evidenced by: Licensee cashed and deposited two of R1's checks into facility bank account which poses an immediate health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 27, 2025

Plan of correction: Licensee agrees to submit a plan on how this regulation will be met by POC due date 09/29/25.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(15) · Plan of correction due date: Sep 29, 2025

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (15) To send and receive unopened correspondence in a prompt manner. This requirement was not met as evidenced by: Licensee opened R1's mail without permission which poses a health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 27, 2025

Plan of correction: Licensee agree to conduct a staff training on personal rights and will submit training date and agenda by POC due date 09/29/25.

Allegation investigated: Staff are not allowing residents to have full access to the facility.

Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the initial complaint investigation visit. LPA met with and discussed the allegation with Administrator (AD) Mandy Rancour. Investigation findings were delivered during this visit to AD. During the visit, LPA toured the Assisted Living common areas of the community, including outdoors. LPA conducted staff and resident interviews as well as record review of facility documents. Copies were provided as requested. Upon arrival, residents were observed sitting in the lobby area. Multiple residents were interviewed with consistant reports that all common areas including the lobby and restrooms near the lobby are open to residents and visitors. LPA was able to access the restrooms multiple times during the visit. This Agency has investigated the allegation listed above. We have found that the allegation is UNFOUNDED, therefore we have dismissed the allegation. There were no citations issued. An exit interview was conducted and a copy of this report was left with AD. Unfoundedthe state’s words, verbatim · CDSS document, Aug 21, 2025 · control 24-AS-20250813164158

Type of visit: Required - 1 Year

On 7/9/2025, Licensing Program Analyst (LPA) K. J. Leffall arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit and met with Administrator(A1) Mandy Rancour. LPA conducted facility tour with A1. LPAs observed required posting. All pathways, entrances and exits were clear from obstruction. LPA toured locked office storage rooms, and laundry rooms. LPA observed facility common areas which were furnished with sufficient seating. The tour continued to the facility dining room and facility kitchen. The kitchen was observed clean, in good repair with necessary items and appliances. LPA did not observe 7-day supply of nonperishable food. 2-Day perishable foods observed. LPA toured several resident rooms which were observed to be furnished with required furniture and adequate lighting. Fire extinguishers observed throughout the facility with service date of 2/10/25. Bathrooms were properly equipped with non-slip mats and grab bars. Carbon monoxide detector tested and operational in two hallways. Memory care toured with dining area/ Kitchen; several rooms toured. Residents observed with several caregivers in commons playing a trivia game on television. LPA toured an enclosed patio area with sufficient seating and shade for recreational purposes. LPA observed delayed egress doors. Facility observed with a signal system. LPA toured main outside Patio from dinning room which was observed with seating and shade. Samples of staff and resident files reviewed to have the required documents. Fire drill conducted on 6/6/2025. Annual Fire Alarm inspection & Testing completed on 6/30/2025. LPA reviewed resident's medication, MARS, and Centrally Stored Medication and Destruction Record (CSMDR) No deficiencies issued during this inspection. LPA is requesting the following documents be submitted to the Fresno CCL office by 7/23/2025: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020. An exit interview was conducted. A copy of this report with 9102 was provided to A1, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Jul 9, 2025

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct a case management for an incident that occurred on 5/15/25. LPA met with Administrator Mandy Rancour. LPA reviewed R1's LIC 602. R1 is unable to manage her own medications. LPA interviewed Administrator. R1's 8 AM pills were administered however facility staff did not ensure R1 swallowed her pills. R1's pills were found by staff in the afternoon. R1 has a history of not swallowing administered pills. An exit interview was conducted with the Administrator and a copy of this report was provided with appeal rights and plan of correction.the state’s words, verbatim · CDSS document, May 23, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: May 24, 2025

87465 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: Licensee did not ensure R1 swallowed administered AM medication which was later found in the afternoon which poses an immediate health safety and or personal rights risk.the state’s words, verbatim · CDSS document, May 23, 2025

Plan of correction: Plan of Correction Licensee agrees to conduct a staff training on administering medications. POC was cleared during visit. Training was conducted on 5/16/25 by LVN.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct a case management for an incident occurred . LPA was at the facility and observed additional deficiencies outside of the original incident. LPA met with Administrator Mandy Rancour. During the course of the visit, it was found R1 has an infectious disease. Facility was notified of R1's restricted/prohibited condition after lab results came back on 5/19/25. Facility did not report to Licensing. Facility does not have a restricted health care plan for R1. LPA will return at a later date after a further review is conducted if additional citations are necessary. An exit interview was conducted with the Administrator and a copy of this report was provided with plan of correction and appeal rights. .the state’s words, verbatim · CDSS document, May 23, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(2) · Plan of correction due date: May 30, 2025

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This requirement was not met by: Licensee did not report R1's contagious prohibited condition, which poses a potential health, safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 23, 2025

Plan of correction: Licensee agrees to submit a written understanding of the regulation by POC due date 5/30/25.

Allegation investigated: Facility kitchen sink is in disrepair

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for initial 10-day complaint inspection. LPA met with Executive Director Meshell (Shelley) Ramos and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. Based on observations, interviews conducted with staff the facility kitchen sink disposable has not been operating for a month which causes sink to clog with water. The facility had a plumbing company came to assess the sink, but permanent repair/replacement has not been scheduled. The preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. See citations on the attached LIC9099D. Exit interview was conducted with Administrator and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Dec 5, 2024 · control 24-AS-20241202121948

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(29) · Plan of correction due date: Dec 6, 2024

87555 General Food Service Requirements (b)The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. This requirement was not met as evidenced by: Based on observations and interview the facility kitchen sink disposal has not been operating causing water to buildup in the sink.the state’s words, verbatim · CDSS document, Dec 5, 2024

Plan of correction: Executive Director agrees to obtain estimate of repair/replacement and schedule repair. Once service is completed Executive Director will submit proof of service.

Allegation investigated: Staff performed unsafe transfers resulting in resident sustaining injuries Staff spoke inappropriately to residents Staff handled residents in a rough manner Staff pinched resident

On this date, Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit to deliver findings. LPA met with Administrator Katrina Sinift and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings. The Department conducted interviews and reviewed records. Based on the interviews conducted and records reviewed, the resident sustained multiple bruises and skin tears due to one-person assist instead of following the care plan of 2 person assist. Based on staff and resident interviews staff speak inappropriately to residents and handle the residents in a rough manner as well as threatening residents when they complain. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Citations are issued per Title 22 on the attached LIC9099D page. Citations regarding unsafe transfers was addressed during NCC meeting and cited on another complaint. Exit interview was conducted with Administrator and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Aug 7, 2024 · control 24-AS-20240325154638

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1)(3) · Plan of correction due date: Aug 8, 2024

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by: Based on staff and resident interviews staff we observed speaking rudely to residents and being “rough” when providing care. Interviews revealed when residents required additional support of time residents were intimidated or punished.the state’s words, verbatim · CDSS document, Aug 7, 2024

Plan of correction: Administrator to submit plan of intent by due date to conduct in-service training on Regulation 87468.1 Personal Rights of Residents in All Facilities and submit records when completed.

Allegation investigated: Staff allowed residents to be left in soiled clothing for extended period Staff are not addressing incontinence needs for residents in care Staff are not addressing residents healthcare needs Staff do not ensure residents room is kept free from mal odors Staff do not ensure residents catheter bag is emptied in a timely manner

On this date, Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit to deliver findings. LPA met with Administrator Katrina Sinift and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. Based on Staff interviews and record reviews (R1) had an Autoimmune disease that required clothing changes often due to body fluids. R1 was being seen by multiple doctors however no treatment was available. Records were reviewed that documented catheter care for R2. Based on records review and interview of staff, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore these allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 7, 2024 · control 24-AS-20240326095324

Allegation investigated: Resident sustained injuries due to lack of staff care and supervision. Facility is not adhering to resident's Admission Agreement. Staff are not adequately trained.

On this date, Licensing Program Analyst (LPA) K. Kaur, Licensing Program Manager (LPM) S. Moua, and Regional Manager (RM) B. White met with Katrina Sinift, Administrator and Gary Allinger Regional Director. The above allegations were discussed and findings were delivered. The Department conducted interviews and reviewed records. Based on the interviews conducted and records reviewed, the resident sustained multiple fractures after staff failed to abide by R1’s care plan and the resident fell. Based on interviews conducted, staff admitted to failing to abide by R1’s care plan and continues to conduct one-person assist. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. The issuance of additional civil penalties is pending and currently under review. The details of additional civil penalties will be outlined in a future report to the facility, if any. Citations are issued per Title 22 on the attached LIC 9099D. Appeal rights were given and exit interview was conducted. Substantiatedthe state’s words, verbatim · CDSS document, Jul 30, 2024 · control 24-AS-20240402101858

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Jul 31, 2024

87411(a) Personnel Requirements – General - Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on the interviews conducted and records reviewed, R1 sustained multiple fractures after staff failed to abide by R1’s care plan and fell, which poses an immediate health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, Jul 30, 2024

Plan of correction: POC – Discussed during the NCC.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(d)(3) · Plan of correction due date: Jul 31, 2024

87411(d)(3) Personnel Requirements – General - Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement was not met as evidenced by: Based on the interviews conducted and records reviewed, staff were not trained on two person transfers of R1, which poses an immediate health and safety risk.the state’s words, verbatim · CDSS document, Jul 30, 2024

Plan of correction: POC – Discussed during the NCC.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(f) · Plan of correction due date: Jul 31, 2024

87507(f) Admission Agreements - The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement was not met as evidenced by: Based on the records reviewed and interviews conducted, staff failed to abide by the resident’s care plan of providing 2 person transfers for R1, which poses a potential health and safety risk.the state’s words, verbatim · CDSS document, Jul 30, 2024

Plan of correction: POC – Discussed during the NCC.

Type of visit: Case Management - Deficiencies

On this date, Licensing Program Analyst (LPA) K. Kaur, Licensing Program Manager (LPM) S. Moua, and Regional Manager (RM) B. White met with Katrina Sinift, Administrator and Gary Allinger Regional Director. Based on interviews conducted with Administrator Katrina Sinift during NCC meeting, a medication error occurred a week before Friday. Per Administrator residents had missed medication/ missed dosage from a staff that was new med-tech. Staff has been removed from medications until either further training Deficiencies are being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. An exit interview was conducted with Administrator. Report signed on-site; a copy of this report, 809D with appeal rights was provided.the state’s words, verbatim · CDSS document, Jul 30, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jul 31, 2024

87465(a)(4) Incidental Medical and Dental Care. The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on the interviews conducted Staff missed medicaiton or missed dosage for residents.the state’s words, verbatim · CDSS document, Jul 30, 2024

Plan of correction: POC – Discussed during the NCC.

Type of visit: Required - 1 Year

On 7/16/2024, Licensing Program Analysts (LPAs) K. Kaur and K. Brown arrived unannounced at the above facility to conduct an Annual Inspection. LPAs introduced selves, stated the purpose of the visit and met with Executive Director Katrina Sinift LPA conducted facility tour with Administrator. LPAs observed required posting. All pathways, entrances and exits were clear from obstruction. LPA toured locked office storage rooms, and laundry rooms. LPA observed facility common areas which were furnished with sufficient seating. The tour continued to the facility dining room and facility kitchen. At 10:34 AM LPA observed cleaning solution in cabinet in the dining area. The kitchen was observed clean, in good repair with necessary items and appliances. At 10:46 AM LPA did not observe 7-day supply of nonperishable food. 2-Day perishable foods observed. LPA toured several resident rooms which were observed to be furnished with required furniture and adequate lighting. At 11:44 AM LPA observed in Room 221 Block of knifes on kitchen counter and Chemicals and cleaning supplies under kitchen sink. Fire extinguishers observed throughout the facility with service date of July 8, 2024. Bathrooms were properly equipped with non-slip mats and grab bars. Carbon monoxide detector tested and operational in two hallways. Memory care toured with dining area/ Kitchen; several rooms toured. Residents observed with several caregivers in commons areas assembling puzzles. At 11:19 AM LPA conducted a medication audit of memory care resident and did not observe residents’ response to PRN medication. LPA toured an enclosed patio area with sufficient seating and shade for recreational purposes. LPA observed delayed egress doors. Facility observed with a signal system. LPA toured main outside Patio from dinning room which was observed with seating and shade. At 12:28 PM LPA observed unlocked gardening tools. Cleaning supplies and chemicals are kept locked maintenance room. Resident's records contained signed Admission Agreement, Personal Rights, and current Physician's Report. Staff files were reviewed for good health. It was verified that there are at least two staff on duty who are CPR certified. Continued to next page... Facility files were reviewed for Resident council Meeting record, plan of operation with dementia care policy. Last fire drill conducted on 5/29/2024. Annual Fire Alarm inspection & Testing completed on 2/28/2024. LPA reviewed resident's medication, MARS, and Centrally Stored Medication and Destruction Record (CSMDR) Deficiencies are being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. LPA is requesting the following documents be submitted to the Fresno CCL office by 7/23/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020. An exit interview was conducted with Administrator. Report signed on-site; a copy of this report, 809D with appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 16, 2024

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff did not treat resident with dignity or respect

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit to deliver findings. LPA met with Michael Herrera, LVN and explained the purpose of the visit and reviewed the elements of the allegations. Administrator Katrina Sinift was not available. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. No evidence was forthcoming to determine that Staff did not treat resident with dignity or respect. Based on records review and interview of staff, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore these allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 27, 2024 · control 24-AS-20240311112418

Allegation investigated: Staff did not ensure that resident could access call button Staff did not provide adequate food service to resident

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit to deliver findings. LPA met with Michael Herrera, LVN and explained the purpose of the visit and reviewed the elements of the allegations. Administrator Katrina Sinift was not available. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. Based on interviews, record review and observations resident did have access to a call button and pendant. Based on residents’ physical capacity it is undetermined if resident could utilize either. Resident was provided meals in room with the assistance of staff. Resident was new the facility and hadn’t adjusted to the facility meal schedule. The above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore these allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 27, 2024 · control 24-AS-20240321081156

Type of visit: Case Management - Deficiencies

On 3/13/2024, Licensing Program Analyst (LPA) K.Kaur arrived unannounced for complaint inspection and conducted a case management in conjunction. LPA met Administrator Katrina Sinift and introduced self and explained the reason for the visit. While conducting a tour of the facility LPA the maintenance room to be unlocked. LPA observed unlocked Clorox Bleach Cleaner, Bleach Wipes, sharp tools, aerosol cans. Deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. An exit interview was conducted with Administrator including discussing the plan of corrections. Report signed on-site. Printed copy provided with 809D page and appeal rights.the state’s words, verbatim · CDSS document, Mar 13, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Mar 14, 2024

87309(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in 1 out of 1 unlocked maintenance room that contained Clorox Bleach Cleaner, Bleach Wipes, sharp tools, aerosol cans which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 13, 2024

Plan of correction: Administrator to submit a statement in writing regarding plans to provide an in-service training to all staff and submit by due date. Training records to be submitted as completed.