Autumn Oaks

Allegation investigated: “This report is being amended to update the reporting manager.” Staff did not assist resident with medical appointments

Licensing Program Analyst (LPA) L. Xiong conducted the subsequent complaint investigation visit to the facility. During the course of this complaint investigation LPA interviewed staff and obtained and/or reviewed facility records. It was determined based on the interviews and records review that the above allegation is SUBSTANTIATED. The evidence from the investigation indicated that doctor's appointment was missed. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.”) Substantiatedthe state’s words, verbatim · CDSS document, Nov 14, 2025 · control 24-AS-20251103165446

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Nov 17, 2025

“This report is being amended to update the reporting manager.” 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: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. LPA observed from the investigation that doctor's appointment was missed.the state’s words, verbatim · CDSS document, Nov 14, 2025

Plan of correction: Facility closed, no further correction necessary.

Allegation investigated: “This report is being amended to update the reporting manager.” Facility is in disrepair Facility does not provide resident with proper window dressings Staff mismanaged residents' medications

On 10/30/2025, Licensing Program Analyst (LPA) L. Xiong arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit and met with the Licensee. During the course of the investigation, LPA reviewed records, conducted a facility tour and interviewed residents and staff. It was determined that the above allegations: Facility is in disrepair, Facility does not provide resident with proper window dressings, and Staff mismanaged residents' medications are SUBSTANTIATED. During a facility tour conducted on 9/24/2025, it was observed that the facility is in disrepair and has not been maintained by the Licensee. Licensee was informed that the following areas were in disrepair: resident bathrooms, resident rooms, facility shower bathroom, facility exit doors, the perimeter fence, the facility kitchen and facility food pantry. Deficiencies were cited on case management visit conducted on 10/23/2025. During the tour, it was found that multiple windows were missing blinds or window dressings, and the window dressing that were covering the window, were dirty and in need of replacement. Deficiencies were cited on case management visit conducted on 10/23/2025. During the tour, a small box of medications were observed to be hidden in R1’s closet. Per R1, the medications were placed in the facility dumpster and R1 retrieved them. A deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 6 on the attached 9099D. Exit interview conducted and a plan of correction was reviewed and developed. A copy of this report and appeal rights were discussed and provided to the Licensee. Report signed on-site. Substantiatedthe state’s words, verbatim · CDSS document, Oct 30, 2025 · control 24-AS-20250908102257

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Oct 31, 2025

“This report is being amended to update the reporting manager.” 87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication… This requirement was not met as evidenced by: Based on observations and interviews, the Licensee did not comply with this section when medications were observed to be accessible to persons other than the employees, which is an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: Licensee has submitted a closure plan and has notified the Department that the Licensee will surrender the facility license.

Allegation investigated: “This report is being amended to update the reporting manager.” Staff did not provide nutritious meals to residents in care Staff did not store perishable foods in covered containers Staff retained expired foods at the facility for residents in care

Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation to the facility. During the course of this investigation, LPA reviewed facility files relevant to the complaint and conducted a facility tour. It was determined that the above allegations: Staff did not provide nutritious meals to residents in care, Staff did not store perishable foods in covered containers, and Staff retained expired foods at the facility for residents in care are SUBSTANTIATED. The evidence from the investigation indicated that the facility is not practicing proper storing of food. Facility did not have food labeled and dated, they were not utilizing proper freezer storage and were storing food in broken and dirty refrigerators. Facility was not following a menu and would cook meals that were “going to expire”. It was observed that residents received a hamburger and cauliflower for lunch. The hamburger did not include any condiments or toppings. The facility received food from a local food bank that were close to the best buy date and did not prepare the meals prior to the best buy date. The deficiencies for this complaint were issued during a case management visit conducted on 10/23/2025. Licensee has submitted a closure plan for the facility. Exit interview conducted. A copy of this report was discussed and provided to Licensee, whose signature on this form confirms receipt of this document. Substantiatedthe state’s words, verbatim · CDSS document, Oct 30, 2025 · control 24-AS-20250829085950

Allegation investigated: “This report is being amended to update the reporting manager.” Staff engages in various forms of physical abuse with resident in care

On 10/30/2025, Licensing Program Analyst (LPA) L. Xiong arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit and met with the Licensee. During the course of the investigation, LPA reviewed records, conducted a facility tour and interviewed residents and staff. It was determined that the above allegations: Staff engages in various forms of physical abuse with resident in care is UNSUBSTANTIATED. 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. No deficiencies issued. Exit interview conducted. A copy of this report was discussed and provided to Licensee. Report signed on-site. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 30, 2025 · control 24-AS-20250829085606

Allegation investigated: “This report is being amended to update the reporting manager.” Staff does not ensure facility is kept free of pests Staff speaks inappropriately to residents in care Staff does not ensure residents personal property is safely secured

On 10/30/2025, Licensing Program Analyst (LPA) L. Xiong arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit and met with the Licensee. During the course of the investigation, LPA reviewed records, conducted a facility tour and interviewed residents and staff. It was determined that the above allegations: Staff does not ensure facility is kept free of pests, Staff speaks inappropriately to residents in care and Staff does not ensure residents personal property is safely secured are SUBSTANTIATED. The evidence from the investigation indicated that the facility has a roach and bed bug infestation. Although the facility is receiving pest control services, the service selected is not sufficient as the Licensee has pest control “only spray a few rooms”. Based on interviews conducted, it was found that the Licensee told R1 “that she would give R1 $2000, if R1 leaves” while Licensee presented an eviction notice to R1. Interviews with Administrator revealed that facility staff recently “deep cleaned” and disposed of items belonging to previous residents that resided at the facility. Licensee stated that current resident clothing was not disposed of unless the residents placed a trash bag in the hallway. However, upon review of records, it was discovered that the Licensee did not maintain accurate records of resident’s personal belongings. Deficiencies are being cited in accordance with California Code of Regulations, Title 22, Division 6 on the attached 9099D. Exit interview conducted and a plan of correction was reviewed and developed. A copy of this report and appeal rights were discussed and provided to the Licensee. Report was signed on-site. Substantiatedthe state’s words, verbatim · CDSS document, Oct 30, 2025 · control 24-AS-20250829085606

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f) · Plan of correction due date: Oct 31, 2025

“This report is being amended to update the reporting manager.” 87464 Basic Services (f) Basic services shall at a minimum include: (2) Safe and healthful living accommodations and services… this requirement was not met as evidenced by: Based on interviews and observations, the Licensee did not comply with this section when did not address the roach and bed bug infestation sufficiently resulting in 24 out of 24 residents to be living unsafe living conditions… which is an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: Licensee has submitted a closure plan and has given notice that the Licensee will surrender the facility license.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Oct 31, 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:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons… This requirement was not met as evidenced by: Based on interviews, the Licensee did not comply with this section when the Licensee stated that she would give $2000 to R1 if R1 would leave while serving an eviction notice. Which is a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: Licensee has submitted a closure plan and has given notice that the Licensee will surrender the facility license.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87218(a)(1) · Plan of correction due date: Oct 31, 2025

87218 Theft and Loss (a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153.(1) The initial personal property inventory shall be completed by the licensee, and the resident, or the resident’s representative… This requirement was not met as evidenced by: Based on record review and interviews, the Licensee did not comply with this section when the personal property for each resident was not inventoried upon admission… which is a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: Licensee has submitted a closure plan and has given notice that the Licensee will surrender the facility license.

Allegation investigated: “This report is being amended to update the reporting manager.” Staff do not ensure that bathrooms have towels Staff do not ensure resident has clean bedding Staff do not provide adequate food service

This is an amended report. Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation to the facility. During the course of this investigation, LPA reviewed facility files relevant to the complaint and conducted a facility tour. It was determined that the above allegations: Staff do not ensure that bathrooms have towels, Staff do not ensure resident has clean bedding, and Staff do not provide adequate food service are SUBSTANTIATED. The evidence from the investigation indicated the facility did not have a sufficient supply of linen to provide to 24 residents. Licensee did not ensure clean linen were in use by residents at all times. Towels were observed to have holes and discoloration. Resident bedding was observed to dirty and damaged with holes exposing the comforter’s inner filling. Facility staff did not provide the residents with clean bedding when requested. Evidence from the investigation revealed that the facility is not properly storing food and was not providing food that is in good quality to the residents in care. Deficiencies are being issued in accordance with California Code of Regulations, Title 22, Division 6 on the attached 9099D. Exit interview conducted and a plan of correction was developed with the Licensee. A copy of this report and appeal rights were discussed and provided to the Licensee, whose signature on this form confirms receipt of this document. Substantiatedthe state’s words, verbatim · CDSS document, Oct 30, 2025 · control 24-AS-20250618114755

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(a) · Plan of correction due date: Oct 31, 2025

“This report is being amended to update the reporting manager.” 87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents… This requirement was not met as evidenced by; Based on observations, the Licensee did not comply with this section when the facility did not properly store or provide meals of good quality and quantity to meet the needs of the residents. Licensee has submitted a closure plan to surrender the facility license. POC clearedthe state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: POC cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(3)(C) · Plan of correction due date: Oct 31, 2025

87307 Personal Accommodations and Services (a)(3)(C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited… This requirement was not met as evidenced by; Based on observation, the Licensee did not comply with this section when linens including bathroom linens and bedding were not sufficient in quality or quantity, which is a potential health and safety risk to persons in care. Licensee has submitted a closure plan to surrender the facility license.the state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: POC cleared.

Type of visit: Case Management - Health Checks

“This report is being amended to update the reporting manager.” LPA was at the above facility for a case management health and safety check visit. I met with Licensee Lisa Ong and informed her the purpose of the visit. Today Tulare County Health & Human Services Agency (TCHHSA) relocated 2 to St. Michaels, 4 to Sierra Valley Rehab.(SV), 1 is at Khaweah Hospital (KH) in Visalia, 1 is in Jail and 2 still need medical assessment so they will remain in the facility until tomorrow. According to TCHHSA, the residents that went to SV, KH and jail will be place in an appropriate home when they are discharged. The 2 residents still at the facility will be relocated to St. Michaels in Dinuba today.the state’s words, verbatim · CDSS document, Oct 29, 2025

Type of visit: Case Management - Health Checks

“This report is being amended to update the reporting manager.” LPA was at the above facility conducting a case management health and safety check. I met with Administrator Tony Ong and Licensee Lisa Ong. The three meal were provided by meals on wheels and snacks were provided by the facility. Tulare County Mental Health team were on the premises providing assessment and help with the relocation of the residents. Today, a total of 14 residents were able to be relocated. Of the remaining 10 residents, 2 are in the hospital/medical clinic/rehab., 1 in jail and 7 are still in the facility awaiting further assessment. Tulare County Mental team will return tomorrow. There were three staff on duty during the visit.the state’s words, verbatim · CDSS document, Oct 28, 2025

Type of visit: Case Management - Health Checks

“This report is being amended to update the reporting manager.” LPA was at the above facility for a health and safety case management visit. LPA met with Administrator Tony and Licensee Lisa Ong. Tulare County Mental Health Team that came to conduct assessment for the residents just left during my arrival. Diner was delivered and served while I was still on the premises. During a facility tour, I came across resident 1 (R1) who was not accounted for during my previous visit. With the additional resident, the resident currently has 24 residents. There were three staff present during my visit.the state’s words, verbatim · CDSS document, Oct 27, 2025

Type of visit: Case Management - Health Checks

“This report is being amended to update the reporting manager.” LPA was at the above facility to conduct a case management health and safety check. LPA met with on Licensee Lisa Ong and informed her the purpose of the visit. Staffs present at the facility were Administrator, Tony Ong and Ligaya Escario. A tour of the facility were ducted. LPA spoke to licensee and residents that were awake and confirmed breakfast and lunch were delivered by by Meals on Wheals. Dinner was delivered while LPA was still on the premises. LPA informed Lisa Ong that the facility can't use the facility's kitchen to cook food, if they must provide food, they will need to have it catered.the state’s words, verbatim · CDSS document, Oct 26, 2025

Type of visit: Case Management - Health Checks

“This report is being amended to update the reporting manager.” LPA was at the above facility to conduct a case management health and safety check. LPA met with on duty staff L. Escario and informed her the purpose of the visit. A tour of the facility were ducted. The residents from rooms 22 and 18 were relocated to rooms 12 and 21 due to bedbugs and/or bedbug treatment. The residents that were awake and I was able to have a conversation with all indicated they got breakfast and lunch from outside food delivery. They also indi cated that the facility is closing and they will be moving to St. Michael's in Dinuba. L. Escario was the only staff on duty during my visit.the state’s words, verbatim · CDSS document, Oct 25, 2025

Type of visit: Case Management - Other

“This report is being amended to update the reporting manager.” On 10/23/2025, Licensing Program Analyst (LPA) L. Xiong arrived unannounced to conduct a case management inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator or Licensee. The staff on duty, Ligaya Escario stated Lisa O. just left the facility. LPA called and spoke to Lisa Ong and she stated she will be back to the facility soon. After a short time, Licensee, Lisa Ong arrived and met with LPA at the facility. Upon arrival, there were two staff on duty. The purpose of today’s visit is to issue deficiencies that were observed during a case management – Health Checks inspection conducted on 09/24/2025. During this inspection, the following deficiencies were observed: LPA and LPM observed a broken air conditioning unit, soda machine and water dispenser in the dining area. In the kitchen area, insect killer was observed to be stored in the kitchen along with paint and plant fertilizer. The walk-in freezer was observed to be broken, Licensee is utilizing the walk-in freezer to store food that requires refrigeration. LPA and LPA observed, the facility serving food that was past the best buy date. Locked freezers and food storage were observed. Facility did not store or label food to protect the safety, acceptability and nutritive values. The pantry was observed to be in need of cleaning, evidenced by dead and live roaches and spiders throughout the pantry and on shelves holding food. Two refrigerators were observed to be broken and not in use. LPA and LPM observed unsafe food service practices while Licensee was preparing lunch. LPA and LPM observed the air return filters to be dirty and in need of replacement. The facility has 3 bathrooms with shower areas, Licensee locked 2 bathrooms preventing residents from using them. The shower in the unlocked bathroom was not operational. LPA and LPM toured resident bedrooms. The curtains in the residents room appeared to have dead pests and pest feces on them. Blood stained bedding was observed along with bedding that had holes and was in need of replacement. In room 22, LPA and LPM observed two black-widow spiders and dead bed bugs on the walls. Bed bugs were also observed on the resident’s bedding. Linen and bedding supplies were observed, it was found that the linens were not in good condition with multiple holes. LPA and LPM observed a large hole in the wall of the laundry room. Review of records revealed that the Licensee did not have current and complete records for both resident and staff. Interviews revealed that the Administrator has not been present at the facility due to personal circumstances. The facility was not staffed with a sufficient amount of personnel to provide the services to meet the resident’s needs. LPA and LPM were unable to review medications at this time. Deficiencies are being cited in accordance with Title 22 regulations, Division 6 CCR on the attached 809D. Exit interview was conducted and a plan of correction was reviewed and developed with the Licensee. A copy of this report and appeal rights were provided. Report was signed by facility staff.the state’s words, verbatim · CDSS document, Oct 23, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(a) · Plan of correction due date: Oct 31, 2025

“This report is being amended to update the reporting manager.” 87555 General Food Services Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. Evidenced by: Based on observation, the facility did not comply with this section when the Facility did not provide meals that were of a good quality and quantity to meet the resident’s needs, served food that was past the best buy date, served food from damaged containers and stored food in a broken freezerthe state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per Licensee, the facility shall complete the POC by the due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(9) · Plan of correction due date: Oct 31, 2025

87555 General Food Service Requirements (b) The following food service requirements shall apply: (9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. Evidenced by: Based on observation, the facility did not comply with this section when the facility stored food in trash bags, did not utilize freezer safe food storage, label food in the freezer; Facility did not take safety precautions while preparing food to guard meals against pests.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per Licensee, the facility shall complete the correction by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87555(b)(26) · Plan of correction due date: Oct 31, 2025

87555 General Food Service Requirements (b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. Evidenced by: Based on observation, Licensee did not meet the requirements for this section when the facility was not supplied with a one-week supply of non-perishable foods and a two day supply of perishable foods.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per Licensee, the facility shall complete the correction by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(27) · Plan of correction due date: Oct 31, 2025

87555 General Food Service Requirements (b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. Evidenced by: Based on observations, Licensee did not comply with this section when roaches and spiders were observed in the pantry and walk-in freezer.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per Licensee, the facility shall complete the correction by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(24) · Plan of correction due date: Oct 31, 2025

“This report is being amended to update the reporting manager.” 87555 General Food Service Requirements (b) The following food service requirements shall apply: (24) Pesticides and other toxic substances shall not be stored in food storerooms, kitchen areas, or where kitchen equipment or utensils are stored. Evidenced by: Based on observations, Licensee did not comply with this section when Insect Killer, plant fertilizer, and paint were observed to be stored in the kitchen areathe state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per licensee, the facility shall complete the correction by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(29) · Plan of correction due date: Oct 31, 2025

(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. Evidenced by: Based on observations, Licensee did not comply with this section when the facility had multiple broken refrigerators and the walk-in freezer was broken and being utilized as food storage area.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per licensee, the facility shall complete the correction by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87555(b)(16) · Plan of correction due date: Oct 31, 2025

(b) The following food service requirements shall apply: (16) In facilities licensed for sixteen (16) to forty-nine (49) residents, one person shall be designated who has primary responsibility for food planning, preparation and service. This person shall be provided with appropriate training. Evidenced by: Based on observation, the facility did not comply with this section when the facility did not have a person designated for food planning, preparation and service.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per licensee, the facility shall complete the correction by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(6) · Plan of correction due date: Oct 31, 2025

(b) The following food service requirements shall apply: (6) In facilities for sixteen (16) persons or more, menus shall be written at least one week in advance and copies of the menus as served shall be dated and kept on file for at least 30 days. Facilities licensed for less than sixteen (16) residents shall maintain a sample menu in their file. Menus shall be made available for review by the residents or their designated representatives and the licensing agency upon request. Evidenced by: Based on observation, the facility did not comply with this section when the Licensee did not utilize or follow the facility menu and would only servedfood items that were close to expirationthe state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per licensee, the facility shall complete the correction by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Oct 31, 2025

“This report is being amended to update the reporting manager.” 87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs… Evidenced by: Based on observations, Licensee did not comply with this section when the Licensee was the only staff on duty and was unable to provide the services necessary to meet the needs of all residents in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per licensee, the facility complete the correction by the POC date

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Oct 31, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors… Evidenced by: Based on observations, Licensee did not comply with this section when multiple refrigerators and freezers were observed in the facility. When a broken air conditioning unit, broken water dispenser and broken soda machine were observed in the dining area. Multiple blinds were observed to be missing in the residents’ rooms. 2 out of 2 vent return filters were observed to be dirty and in need of replacement, the curtains in the residents’ room were dirty, covered in dead pests and pest feces, the unlocked bathroom shower was non-operational, the bathroom floors and surfaces were in need of cleaning and repair. A large hole in the wall was observed in the laundry room.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per licensee, the facility shall complete the correction by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR97303(c) · Plan of correction due date: Oct 31, 2025

87303 Maintenance and Operation (c) All window screens shall be clean and maintained in good repair. Evidenced by: Based on observation, the facility did not comply with this section when multiple window screens needed replacement or repair.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per licensee, the facility shall complete the correction by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(3) · Plan of correction due date: Oct 31, 2025

87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function … (3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of: (C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. Evidenced by: Based on observation, the facility did not comply with this section when the Licensee did not have a sufficient number of linens that were in good repair and when residents were utilizing bedding that was stained with blood.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per licensee, the facility shall complete the correction by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(b) · Plan of correction due date: Oct 31, 2025

“This report is being amended to update the reporting manager.” 87307 Personal Accommodations and Services (b) Toilets and bathrooms shall be conveniently located. The licensed capacity shall be established based on Section 87158, Capacity, and the following (2) At least one bathtub or shower for each ten (10) persons, which includes residents, family and live-in personnel. Evidenced by: Based on observation, the facility did not comply with this section when the license locked 2 out of 3 bathrooms equipped with a bathtub or shower preventing residents from using it.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per licensee, the facility shall complete the correction by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Oct 31, 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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. Evidenced by: Based on observation, the facility did not comply with this section when the Licensee did not accord dignity and respect in her interaction with residents in care and when Licensee threw out resident belongings without permission.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per licensee, the facility shall complete Personnel training by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.1(a)(2) · Plan of correction due date: Oct 31, 2025

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. Evidenced by: Based on observation, the facility did not comply with this section when the residents in room 22 where not relocated to a room without bed bugs as recommended and when the Licensee locked the refrigerators in the facility.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per licensee, the facility shall complete training by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Oct 31, 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 Evidenced by: Based on observation, the facility did not comply with this section when the Licensee did not have a completed and current record for 22 out of 22 residents in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per kicensee, the facility shall complete correction by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(a) · Plan of correction due date: Oct 31, 2025

“This report is being amended to update the reporting manager.” 87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility … Evidenced by: Based on observation, the facility did not comply with this section when the Administrator was not present a sufficient amount of hours to run the facility.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per licensee, facility shall complete the correction by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a) · Plan of correction due date: Oct 31, 2025

87412 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Evidenced by: Based on observation, the facility did not comply with this section when the Licensee did not have a completed and current record for all staff employed at the facility.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Per licensee, facility shall complete the correction by the POC due date.

Type of visit: Case Management - Health Checks

“This report is being amended to update the reporting manager.” LPA Les Xiong, LPM Alexandria Walton, Ombudsman Maribel Martinez and Bobbie Wartson was at the above facility to conduct a health and safety check. A tour of the facility was conducted during the visit. Deficiencies observed will be cited at a later date.the state’s words, verbatim · CDSS document, Sep 24, 2025

Allegation investigated: “This report is being amended to update the reporting manager.” Staff do not safeguard residents' personal property

This is an amended report. Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation to the facility. During the course of this investigation, LPA reviewed facility files relevant to the complaint and conducted a facility tour. During the course of this investigation LPA reviewed facility files relevant to the complaint investigation. It was determined that the above allegation: Staff do not safeguard residents' personal property is UNSUBSTANTIATED. 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. No deficiencies issued. Exit interview conducted. A copy of this report was discussed and provided to the Licensee. Report signed on-site. Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 5, 2025 · control 24-AS-20250618114755

Type of visit: Office

“This report is being amended to update the reporting manager.” On 08/19/2025, an informal meeting was held at the Fresno Regional Office. The purpose of the informal meeting was to discuss recently identified issues/concerns associated with the operation of the facility. The informal meeting process was explained during this meeting. The following were in attendance at this meeting: Licensee, Lisa Ong Administrator, Antonio Ong Licensing Program Manager I, Alexandria Walton Licensing Program Analyst, Les Xiong During this meeting the following topics were discussed; · Food Service · Buildings and Grounds · Finances Licensee was provided with all applicable regulations. A copy of this report was discussed and provided to the Licensee.the state’s words, verbatim · CDSS document, Aug 19, 2025

Type of visit: Required - 1 Year

“This report is being amended to update the reporting manager.” Today, Licensing Program Analyst L. Xiong arrived at the facility unannounced to conduct the . LPAs met with Licensee Lisa Ong and informing her the purpose of the visit. LPA toured the facility with staff. Facility appeared clean with no obstruction or fire clearance issues. All common areas have adequate seating and lighting. Resident bedrooms toured, rooms observed to have all required accommodations. Kitchen toured, LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food available for residents. Smoke detector and carbon monoxide detectors observed operational during inspection. Fire extinguisher present with a service date of 12/2024. Water temperature observed to measure at 105 degrees F. No deficiencies were observed.the state’s words, verbatim · CDSS document, Jul 30, 2025

Allegation investigated: “This report is being amended to update the reporting manager.” Staff did not ensure that the facility is kept clean. Facility did not ensure that staff are properly trained to dispense medication. Staff did not ensure that residents dietary needs are being met. Staff made an inappropriate request of residents in care. Staff are tampering with residents mail.

Licensing Program Analyst (LPA) 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 allegations: Staff did not ensure that the facility is kept clean, Facility did not ensure that staff are properly trained to dispense medication, Staff did not ensure that residents dietary needs are being met, Staff made an inappropriate request of residents in care, Staff are tampering with residents mail are UNFOUNDED. The evidence from the investigation indicated facility has house keeper cleaning the facility daily, staff that administered medication is properly trained, residents in the facility does not have doctor ordered special diet, staff did not inappropriately request of residents, and did not tamper residents' mail. This agency has investigated the complaint alleging (Staff did not ensure that the facility is kept clean, Facility did not ensure that staff are properly trained to dispense medication, Staff did not ensure that residents dietary needs are being met, Staff made an inappropriate request of residents in care, Staff are tampering with residents mail). We have found that the complaint was unfounded, therefore we have dismissed the complaint. Unfoundedthe state’s words, verbatim · CDSS document, May 2, 2025 · control 24-AS-20241125232111

Allegation investigated: “This report is being amended to update the reporting manager.” Staff did not follow physician’s laboratory orders for resident.

Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. During the course of this investigation LPA reviewed facility files and interview staff relevant to the complaint investigation. It was determined that the above allegation: Staff did not follow physician’s laboratory orders for resident is UNFOUNDED. The evidence from investigation indicated that resident went to see her doctor on 11/15/24 and went back to have her lab work done on 11/20/24, which is what the doctor ordered. This agency has investigated the complaint alleging (Staff did not follow physician’s laboratory orders for resident). We have found that the complaint was unfounded, therefore we have dismissed the complaint. Unfoundedthe state’s words, verbatim · CDSS document, Mar 13, 2025 · control 24-AS-20241118102129

Allegation investigated: “This report is being amended to update the reporting manager.” Staff restricted resident from using personal belongings. Staff threatened resident. Staff do not prevent residents from smoking in non-smoking areas of the facility. Staff assaulted resident.

Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. During this visit LPA delivered investigation findings regarding the above allegations.The Department has investigated the complaint alleging: Facilty staff handled resident roughly. Staff restricted resident from using personal belongings, Staff threatened resident, Staff do not prevent residents from smoking in non-smoking areas of the facility, and Staff assaulted resident are UNSUBSTANTIATED. LPA observed from the investigation that the evidence of staff restricting resident from using personal belongs, threatening resident, not preventing residents from smoking in the non-smoking areas and assaulted resident was supported or consistent among all the people interviewed. 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. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 3, 2025 · control 24-AS-20240701160550

Allegation investigated: “This report is being amended to update the reporting manager.” Facility is not providing residents with adequate food. Facility has rodants in the kitchen and resident rooms.

Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. During the course of this investigation LPA spoke to residents and staff relevant to the complaint investigation. It was determined that the above allegation: Facility is not providing residents with adequate food, and Facility has rodants in the kitchen and resident rooms are UNFOUNDED. LPA observed from the evidence from the investigation that there were adequate food and there were no rodents in the kitchen and residents' room since. This agency has investigated the complaint alleging (Facility is not providing residents with adequate food, and Facility has rodants in the kitchen and resident rooms). We have found that the complaint was unfounded, therefore we have dismissed the complaint. Unfoundedthe state’s words, verbatim · CDSS document, Mar 3, 2025 · control 24-AS-20241015112559

Allegation investigated: “This report is being amended to update the reporting manager.” Staff mismanaged resident’s medication Staff did not ensure residents had access to water

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: Staff mismanaged resident’s medication, and Staff did not ensure residents had access to water are NFOUNDED. The evidence from the investigation indicated medicaions were given as directed by prescribed doctors and water is readily available in the dining room. This agency has investigated the complaint alleging (Staff mismanaged resident’s medication, and Staff did not ensure residents had access to water). We have found that the complaint was unfounded, therefore we have dismissed the complaint. Unfoundedthe state’s words, verbatim · CDSS document, Feb 26, 2025 · control 24-AS-20240607144823

Allegation investigated: “This report is being amended to update the reporting manager.” Staff did not provide adequate food service to resident in care. Staff do not ensure residents are served food of good quality.

Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. During this visit LPA delivered investigation findings regarding the above allegations. The Department has investigated the complaint alleging: Staff did not provide adequate food service to resident in care, and Staff do not ensure residents are served food of good quality. The facility tour did not find any expired food and the interviews were inconsistent. Based on the interviews conducted and/or records 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 violations did or did not occur, therefore the allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Feb 26, 2025 · control 24-AS-20240528094708

Allegation investigated: “This report is being amended to update the reporting manager.” Staff did not ensure correct medications were dispensed to resident in care

Licensing Program Analyst (LPA) L. Xiong conducted complaint investigation visit to the facility. During the course of this complaint investigation LPA interviewed staff on duty and obtained and/or reviewed facility records. It was determined based on the interviews and records review that the above allegation is SUBSTANTIATED. LPA's observed from the investigation that facility did send wrong medications for resident R1 when resident visited family on February 3, 4 & 5. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.”) Substantiatedthe state’s words, verbatim · CDSS document, Feb 10, 2025 · control 24-AS-20250207121401

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Feb 19, 2025

“This report is being amended to update the reporting manager.” 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: LPA observed R2's medication was sent home with R1 when R1 went home on February 3, 4 and 5, 2025.the state’s words, verbatim · CDSS document, Feb 10, 2025

Plan of correction: Per licensee, Upon discovery of the medication error, all staff were retrained on medication administering procedures. LPA obtained training documents while at the facility therefore no further correction is necessary.

Allegation investigated: “This report is being amended to update the reporting manager.” Staff did not ensure that residents are reciving correct medications Facility staff are not dispensing medication as prescribed.

Licensing Program Analyst (LPA) L. Xiong conducted complaint investigation visit to the facility. During the course of this complaint investigation LPA interviewed staff on duty and obtained and/or reviewed facility records. It was determined based on the interviews and records review that the above allegation is SUBSTANTIATED. LPA's observed from the investigation that facility did send wrong medications for resident R1 when resident visited family on February 3, 4 & 5. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.”) Substantiatedthe state’s words, verbatim · CDSS document, Feb 10, 2025 · control 24-AS-20250207112445

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87456(a)(4) · Plan of correction due date: Feb 22, 2025

“This report is being amended to update the reporting manager.” 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: LPA observed R2's medication was sent home with R1 when R1 went home on February 3, 4 and 5, 2025.the state’s words, verbatim · CDSS document, Feb 10, 2025

Plan of correction: Per licensee, Upon discovery of the medication error, all staff were retrained on medication administering procedures. LPA obtained training documents while at the facility therefore no further correction is necessary.

Allegation investigated: “This report is being amended to update the reporting manager.” Facility staff did not safeguard resident’s personal property Facility staff are not dispensing medication as prescribed.

Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. During the course of this investigation LPA reviewed facility files and interviewed staff and resident relevant to the complaint investigation. It was determined that the above allegation: Facility staff did not safeguard resident’s personal property, and Facility staff are not dispensing medication as prescribed are UNFOUNDED. The evidence of the investigation indicated facility staff did safeguard or never touched resident's personal property and medications were administered as prescribed. This agency has investigated the complaint alleging (Facility staff did not safeguard resident’s personal property, and Facility staff are not dispensing medication as prescribed). We have found that the complaint was unfounded, therefore we have dismissed the complaint. Unfoundedthe state’s words, verbatim · CDSS document, Feb 7, 2025 · control 24-AS-20240516130522

Allegation investigated: “This report is being amended to update the reporting manager.” Facility does not safeguard resident's room and personal belingings Facility did not follow required Eviction procedures

Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. During the course of this investigation LPA reviewed facility files and interviewed staff relevant to the complaint investigation. It was determined that the above allegation: Facility does not safeguard resident's room and personal belingings, and Facility did not follow required Evivtion procedures are UNFOUNDED. The evidence from the investigation indicated there was a facility deep cleaning recently but residents were present while the cleaning took place. The record reviewed indicated eviction procedures meet title 22 requirement. This agency has investigated the complaint alleging (Facility does not safeguard resident's room and personal belingings, and Facility did not follow required Evivtion procedures). We have found that the complaint was unfounded, therefore we have dismissed the complaint. Unfoundedthe state’s words, verbatim · CDSS document, Feb 7, 2025 · control 24-AS-20250129144444

Allegation investigated: “This report is being amended to update the reporting manager.” Staff do not ensure facility is free from pests.

Licensing Program Analyst (LPA) L. Xiong conducted complaint investigation visit to the facility. During the course of this complaint investigation LPA interviewed staff on duty. It was determined based on the interviews and records review that the above allegation is SUBSTANTIATED. The evidence from the investigation indicated there were roach observed in room 17 in the facility. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.”) Substantiatedthe state’s words, verbatim · CDSS document, Jan 27, 2025 · control 24-AS-20250117084342

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Feb 3, 2025

“This report is being amended to update the reporting manager.” MAINTENANCE AND OPERATIONS - The facility shall be clean, safe, sanitary and in good repair at all times. The investigation indicated roaches was observed in the facility. This poses an immediate Health and Safety risk to clients in care.the state’s words, verbatim · CDSS document, Jan 27, 2025

Plan of correction: The facility currently has monthly service contract with Sierra Vista Exterminator. Therefore no further correction is needed.

Allegation investigated: “This report is being amended to update the reporting manager.” Unlawful eviction

On 01/23/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct subsequent complaint investigation and deliver findings on the above allegation. LPA introduce self and stated the purpose of the visit. LPA met with Licensee Lisa Ong. During the course of the investigation, LPA conducted interviews and reviewed records. Based on interviews conducted and records reviewed, it was confirmed R1 resided at the facility until 01/15/25. Therefore, the allegation above is UNFOUNDED, meaning they were false, could not have happened, and/or are without reasonable basis. We have therefore dismissed the complaint. Exit interview conducted. A copy of this report was provided to Licensee. Unfoundedthe state’s words, verbatim · CDSS document, Jan 23, 2025 · control 24-AS-20241223134104

Allegation investigated: “This report is being amended to update the reporting manager.” Facility is not safeguarding resident's belongings

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: Facility is not safeguarding resident's belongings is UNFOUNDED. The evidence from the investigation indicated there was a recent deep cleaning of the facility. Residents were present and knows of anything that is thrown away during cleaning of each room. This agency has investigated the complaint alleging (Facility is not safeguarding resident's belongings). We have found that the complaint was unfounded, therefore we have dismissed the complaint. Unfoundedthe state’s words, verbatim · CDSS document, Jan 17, 2025 · control 24-AS-20250108154657

Allegation investigated: “This report is being amended to update the reporting manager.” Staff utilizes a pad lock on the inside of exit doors.

Licensing Program Analyst (LPA) L. Xiong conducted the subsequent complaint investigation visit to the facility. During the course of this complaint investigation LPA interviewed staff on duty and observation during facility tour. It was determined based on the interviews and tour that the above allegation is SUBSTANTIATED. Facility southwest exit door was observed to have a latch with a pad lock. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.”) Substantiatedthe state’s words, verbatim · CDSS document, Dec 18, 2024 · control 24-AS-20240918115204

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Dec 19, 2024

“This report is being amended to update the reporting manager.” 87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. LPA observed southwest exit door locked with a padlock.the state’s words, verbatim · CDSS document, Dec 18, 2024

Plan of correction: The padlock was taken off during the visit. No further correction is needed.

Allegation investigated: “This report is being amended to update the reporting manager.” Staff mismanages residents medication.

Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. I met with Licensee Lisa Ong and informed her the purpose of the visit. During the course of this investigation LPA reviewed facility files relevant to the complaint investigation. It was determined that the above allegation: Staff mismanages residents medication is UNFOUNDED. From the interviews and review of residents' medication and records, there are no errors observed. This agency has investigated the complaint alleging (Lack of supervision resulting in resident's fall). We have found that the complaint was unfounded, therefore we have dismissed the complaint. Unfoundedthe state’s words, verbatim · CDSS document, Dec 18, 2024 · control 24-AS-20240905121635

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Dec 25, 2024

“This report is being amended to update the reporting manager.” 87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. LPA observed dryer not turning on.the state’s words, verbatim · CDSS document, Dec 18, 2024

Plan of correction: Since the date of the complaint, licensee has replaced the problematic dryer with a new unit. No further correction is needed.

Type of visit: Case Management - Other

“This report is being amended to update the reporting manager.” On this date, L. Xiong was at the above facility for a case management visit. A tour of the facility was conducted. The following deficiency is in violation of title 22 div. 6 CCR.the state’s words, verbatim · CDSS document, Nov 15, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303a · Plan of correction due date: Nov 22, 2024

“This report is being amended to update the reporting manager.” MAINTENANCE AND OPERATIONS - The facility shall be clean, safe, sanitary and in good repair at all times. The facility has/had bed bugs. Also, mattress cover was not in good repair. This poses an immediate Health and Safety risk to clients in care.the state’s words, verbatim · CDSS document, Nov 15, 2024

Plan of correction: Facility already has contract with Sierra Vista Exterminators for monthly Pest Control services to treat facility. On 10/22/24 when bedbugs was discovered, the facility was treated for bedbugs and a subsequent treatment was treated on 11/4/24. New mattress covers were ordered for the rooms that were treated. No further correction for the bedbugs treatment, however pictures need to be sent to licensing for once the mattress covers and put on the mattress of the rooms being treated.

Type of visit: Required - 1 Year

“This report is being amended to update the reporting manager.” Today, Licensing Program Analyst L. Xiong was at the facility conductin an unannounced Annual Inspection. LPA met with staff Matilda Garcia and inform her the purpose of the visit. Staff provided facility tour for LPA. Facility appeared clean with no obstruction or fire clearance issues. All common areas have adequate seating and lighting. Resident bedrooms toured, rooms observed to have all required accommodations. Kitchen toured, LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food available for residents.the state’s words, verbatim · CDSS document, Sep 26, 2024

Type of visit: Office

On or about today's date, an informal conference was conducted at the Fresno Adult/Senior Regional Office to discuss issues regarding food, finance and medications. Present during the meeting were licensee Lisa Ong, Administrator Tony Ong, staff Matilda Garcia, Licensing Program Manager Melinda Hoffmann and LPA Les Xiong. During the meeting TSP (Technical Support Program) was offered and accepted by the Licensee and Administrator.the state’s words, verbatim · CDSS document, Jun 14, 2024

Type of visit: Case Management - Other

LPA L. Xiong was at the above facility for a case management visit. A tour of the facility was conducted. Residents 1, 2, 3 & were interviewed during the visit. Visit ended due to licensee having a meeting appointment with Tulare Co. Ombudsman.the state’s words, verbatim · CDSS document, May 22, 2024

Allegation investigated: Facility is in disrepair. Facility is unsanitary.

Licensing Program Analyst (LPA) L. Xiong conducted the subsequent complaint investigation visit to the facility. LPA met with Licensee Lisa Ong and informed her the purpose of the visit. During the course of this complaint investigation LPA interviewed staff on duty and obtained and/or reviewed facility records. It was determined based on the interviews and records review that the above allegations are SUBSTANTIATED. There were a wall in the shower/bathroom across from the laundry room that were not completely repaired and the toilet wasn't flush. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.”) Substantiatedthe state’s words, verbatim · CDSS document, Apr 12, 2024 · control 24-AS-20240119160237

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303 · Plan of correction due date: Apr 19, 2024

87303 Maintenance and Operation LPA observed wall in the shower/bathroom across from the laundry room that were not completely repaired and the toilet wasn't flush.the state’s words, verbatim · CDSS document, Apr 12, 2024

Plan of correction: The wall was not repaired by the handyman at the time of allegation due to moisture and the toilet was not flushed. The wall has already been repaired prior to today and the toilet is working properly. The deficiency has been corrected, no further correction necessarry.

Allegation investigated: Staff did not keep facility free from insects. Facility owner placed a pad lock on the freezer.

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: Staff did not keep facility free from insects, and Facility owner placed a pad lock on the freezer are UNFOUNDED. The evidence from the investigation indicated the facility has monthly contract with Sierra Vista Exterminator to treat facility for all pests and the pad lock is for the additional freezer and the freeze use daily by the facility cook was not locked. In addition, the cook has the key for the pad lock. This agency has investigated the complaint alleging (Staff did not keep facility free from insects, and Facility owner placed a pad lock on the freezer). We have found that the complaint was unfounded, therefore we have dismissed the complaint. Unfoundedthe state’s words, verbatim · CDSS document, Apr 12, 2024 · control 24-AS-20240322111022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(8) · Plan of correction due date: Apr 15, 2024

87555 General Food Service Requirements LPA observed bread expired.the state’s words, verbatim · CDSS document, Apr 12, 2024

Plan of correction: The expired food were thrown out. No further correction needed.

Allegation investigated: Staff did not dispense medication as prescribed. The resident’s room is malodorous.

Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. During this visit LPA delivered investigation findings regarding the above allegations. The Department has investigated the complaint alleging: Staff did not dispense medication as prescribed. The resident’s room is malodorous. Based on the interviews conducted and/or records review the above allegations are UNSUBSTANTIATED. 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. Unsubstantiatedthe state’s words, verbatim · CDSS document, Feb 28, 2024 · control 24-AS-20231113120634

Allegation investigated: Staff interacted inappropriately with a resident

Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. I met with staff Matilde Garcia and informed her the purpose of the visit. During this visit LPA delivered investigation findings regarding the above allegations. The Department has investigated the complaint alleging: Staff interacted inappropriately with a resident. Based on the interviews conducted and/or records 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 violations did or did not occur, therefore the allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Feb 28, 2024 · control 24-AS-20231129120850

Allegation investigated: Staff are not communicating with resident's responsible party Staff are financially abusing resident in care

Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. During this visit LPA delivered investigation findings regarding the above allegations.The Department has investigated the complaint alleging: Staff are not communicating with resident's responsible party and Staff are financially abusing resident in care. Based on the interviews conducted and/or records review the above allegations are UNSUBSTANTIATED. 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. Unsubstantiatedthe state’s words, verbatim · CDSS document, Feb 28, 2024 · control 24-AS-20231129160758