Happy Home Care

Allegation investigated: Due to staff neglect resident developed multiple pressure injuries while in care Staff left resident in soiled linens for an extended period of time Staff did not meet resident's nutritional needs

Licensing Program Analyst (LPA) Quoc Huynh conducted an unannounced subsequent complaint visit to deliver findings for the above allegations. The LPA arrived at 10:04AM and met with Assistant Administrator (AA) Karina Antig who arrived shortly thereafter . Entrance interview conducted. On 08/15/2025 from 11:30am to 2:00pm, an initial visit was conducted by LPA Emily Peraldi. The LPA conducted interviews with the AA and staff, and obtained pertinent documents. The LPA also conducted an interview with hospital personnel on 08/13/2025 at approximately 9:08am and 10:10am. During the investigation, medical records were reviewed including hospital assessments and home health documentation. Report Continued on LIC 9099-C Unsubstantiated On 09/01/2026, LPA Huynh conducted a subsequent visit. Between 12:55PM and 3:16PM, the LPA conducted a physical plant tour and interviewed four (4) residents, two (2) staff, and the AA. During today’s visit, LPA Huynh and Staff toured the physical plant at 10:09AM, and no immediate concerns were observed. The following was then determined: Allegations: “Resident developed multiple pressure injuries due to staff neglect” and “Staff did not meet resident's nutritional needs” It was alleged that R1 developed several pressure injuries due to neglect, lack of repositioning, skin breakdown with excoriation, and sepsis; and that staff did not meet R1’s nutritional needs. R1’s physician’s report dated 12/20/2024 documented multiple chronic and progressive medical conditions including Alzheimer’s disease, chronic kidney disease, anemia, malnutrition, and impaired mobility. The physician’s report was largely incomplete and did not contain current wound information or detailed mobility or nutritional directives. R1’s appraisal dated 04/03/2025 showed R1 had longstanding diagnoses of generalized weakness, severe protein-calorie malnutrition, chronic anemia, hypotension, upper gastrointestinal bleeds, and failure to thrive. The plan documented that R1 preferred to remain in bed due to weakness and poor appetite, and that R1 frequently stated they did not want to eat because they believed they were overweight. The plan also indicated R1 required assistance with all ADLs except feeding, though staff continued to monitor and cue R1 during meals due to refusal. A Home Health assessment (Oct–Dec 2024) described R1 as extremely frail, bedridden, with advanced Alzheimer’s disease, severe functional decline, total ADL dependence, and clinically documented malnutrition and failure to thrive. R1’s weight during this period (78 lbs at 62 inches tall) reflected chronic, progressive medical decline. The assessment noted a Stage 1 pressure injury and identified R1 as high-risk for pressure injuries due to immobility, malnutrition, and fragile skin, requiring ongoing preventative measures. Report Continued on LIC 9099-C A Home Health plan of care (06/03/2025–08/01/2025) documented a Stage 3 pressure injury to the right buttock and Stage 2 injury to the left buttock. Nursing notes reflected ongoing wound care with Calmoseptine and A&D ointment, periodic cleansing, and monitoring. The plan further included directions for frequent repositioning and pressure-ulcer prevention. Notes indicated caregivers were completing wound-care treatments on non-skilled nursing visit days. Records also described minor skin breakdown on the upper back consistent with R1’s fragile skin condition. Home Health records dated 07/21/2025 documented a follow-up visit for a reopened cheek wound caused by R1 scratching. The wound was small, without signs of infection, and was treated and dressed. On 08/07/2025, R1 was transported to the hospital due to decreased mentation. Hospital staff documented pressure injuries on the left lateral side of the body, along with excoriation and malnutrition. However, medical records did not contain full measurements, staging details, or clinical evidence supporting some of the verbal statements made by hospital personnel, including the assertion that R1 had not been repositioned. Additionally, the hospital documentation does not clarify whether changes in R1’s condition occurred prior to facility care, during hospitalization, or as part of R1’s chronic disease progression. R1 had been previously hospitalized several times earlier in the year for anemia and dehydration, consistent with R1’s long-standing medical decline. Regarding nutritional concerns, hospital staff stated R1 appeared emaciated and dehydrated upon arrival. However, facility staff reported consistent efforts to encourage feeding and hydration, noting R1 frequently refused meals and fluids due to poor appetite and cognitive impairment. Staff stated they assisted R1 with feeding despite R1’s ability to self-feed. Over time, R1 became increasingly unable to open their mouth, reflecting significant progression of underlying medical conditions rather than lack of care. Interviews with facility staff revealed R1 and other bed-bound residents were repositioned at least every two hours, and more frequently upon request or when staff observed a need. Report Continued on LIC 9099-C Staff documented contacting Home Health when changes to R1’s skin were observed and maintained photographs showing R1’s condition before and after hospital visits. Staff also stated R1 had a history of extremely sensitive skin and chronic anemia, contributing to bruising and skin fragility unrelated to neglect. Interviews with residents indicated no concerns regarding repositioning or nutritional support. Bedbound residents confirmed staff repositioned them frequently and assisted with meals as needed. Based on interview and record review, although the allegations may have happened or are valid, there is insufficient evidence to prove the alleged violations did or did not occur; therefore, the allegations are deemed UNSUBSTANTIATED at this time. Allegation: “Staff left resident in soiled linens for an extended period of time” It was alleged that R1 was left in soiled bedding or clothing for an extended period of time. Emergency department nursing staff reported that R1’s back exhibited excoriation with bleeding and open skin, which they believed could be consistent with moisture-associated skin damage. Hospital personnel verbally stated that the resident’s back appeared irritated and raw; however, the medical record did not include detailed documentation confirming that the condition resulted from prolonged exposure to soiled linens or from inadequate hygiene care prior to hospitalization. Interviews with facility staff and residents did not reveal concerns about individuals being left in soiled linens. Residents were observed with clean bedding, and none reported issues related to hygiene or linen changes. Staff reported following regular incontinence care and linen-changing protocols. Staff additionally reported that prior to R1’s hospitalizations, staff ensured R1 received incontinence changes. Based on interviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur; therefore, the allegation is deemed UNSUBSTANTIATED at this time. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Sep 24, 2026 · control 29-AS-20250812091649

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Quoc Huynh conducted an unannounced case management visit in conjunction with complaint # 29-AS-20250812091649. The LPA arrived at 10:04AM and met with Assistant Administrator (AA) Karina Antig who arrived shortly thereafter. Entrance interview conducted. LPA Huynh and Staff toured the physical plant at 10:09AM, and no immediate concerns were observed. Throughout the course of the complaint investigation, it was noted that the facility retained Resident #1 (R1) who was documented to have a Stage 3 pressure injury on the right buttock. R1 received home health services to treat the wound; however, a Stage 3 pressure injury is considered a prohibited health condition that required a higher level of care. Home health records and interview with staff also revealed that facility staff provided R1 with wound care and were not licensed to do so. Home health skilled nursing visits documented that “the caregiver stated they are just treating the wounds with A and D ointment and Calmoseptine. No need for dressing. Caregivers are able to do wound care on non sn visits.” Record review of R1’s physician’s report was also incomplete. Report Continued on LIC 809-C During a subsequent complaint visit on 09/01/2026, Resident #2 (R2) was observed with full bed rails. Record review confirmed R2 was not on hospice and the LPA advised the AA to remove the full bed rails, which they agreed. During today’s visit, the full bed rails remained and were not removed as discussed. Pursuant to Title 22 CA Code of Regulations and/or the Health and Safety Code, the following deficiencies were cited (Refer to LIC 809-D). Exit interview conducted. A copy of the appeal rights and report was reviewed and provided.the state’s words, verbatim · CDSS document, Sep 24, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Sep 25, 2026

(a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the above section in R1 had a Stage 3 pressure injury which required a higher level of care which posed an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2026

Plan of correction: The Licensee will provide staff in-service training and review regulations and provide CCLD with a statement of understanding by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87631(a)(1) · Plan of correction due date: Sep 25, 2026

(a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who has a healing wound under the following circumstances: (1) When care is performed by or under the supervision of an appropriately skilled professional. This requirement was not met as evidenced by: Based on interview and record review, the licensee did not comply with the above section in facility staff provided R1 wound care and are not skilled professionals which posed an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2026

Plan of correction: The Licensee willl provide staff in-service training on hospice and wound requirements and provide CCLD with the training materials and staff acknowledgement by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Oct 1, 2026

(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 met as evidenced by: Based on record review, the licensee did not comply with the above section in R1 did not have a completed physician’s report which posed a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2026

Plan of correction: The Licensee will review regulations and provide CCLD with a statement of understanding by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87608(a)(5)(B) · Plan of correction due date: Oct 1, 2026

(a) … Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement was not met as evidenced by: Based on observations and record review, the licensee did not comply with the section above in R2 had full bed rails and was not on hospice which posed a potential safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2026

Plan of correction: The Licensee will remove R2's full bed rails or submit an exception request and provide proof to CCLD by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. Upon arrival, there were two (2) staff and three (3) residents present. The Assistant Administrator Karina Antig was contacted and arrived at 10:35 a.m. Entrance interview conducted. Beginning at 11:08 a.m., the LPA, along with Assistant Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: BEDROOMS: There are four (4) designated resident rooms and one (1) staff room inside the locked garage area, as well as an upstairs area solely dedicated to staff use. LPA observed the resident rooms to contain appropriate linens and furnishings. RESTROOMS: The facility contains two (2) shared resident restrooms and one (1) staff restroom upstairs. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature initially measured slightly high, but was adjusted during today's visit. LPA will retest the water during the continuation visit. COMMON AREAS: The common areas including the dining room and living room were observed to be properly furnished at the time of the visit. A fireplace in the living room had a screen. Two (2) fire extinguishers were observed to be fully charged and last serviced 05/20/2025. Service is scheduled. The LPA observed required postings throughout the common space. At 12:13 p.m., the hardwired combination smoke and carbon monoxide detectors were tested and all functioned properly. Report Continued on LIC 809-C KITCHEN: The kitchen area was observed to be adequately cleaned and appliances appeared to be functional. There was an adequate supply of perishable and non-perishable items. Knives and other sharps were observed to be locked under the kitchen sink. GARAGE AND GROUNDS: The garage is attached to the house and locked at all times. The laundry room is in the garage locked and inaccessible. Cleaning supplies and disinfectants are kept in cabinets in the garage. There is one (1) additional refrigerator and one (1) freezer in the garage with perishable items. Facility has an adequate amount of emergency food and emergency water. Outdoor area was observed and appeared adequate for resident use. There is one gate, which does latch, but at this time was not self-closing. No residents were observed to have unsafe wandering or elopement behaviors. Assistant Administrator was advised to repair the self-latching function of the gate should the facility plan to accept any residents with unsafe wandering or elopement behaviors. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's emergency disaster plan, which was complete and updated annually as required. Disaster drills are conducted quarterly, with the last documented drill on 04/18/2026. Infection control plan will be reviewed during the continuation visit. RECORDS/MEDICATIONS: Beginning at 11:36 a.m., LPA reviewed three (3) resident files. All resident files observed contained all required documents. Staff files will be reviewed during the annual continuation visit. Locked medication storage was observed adjacent to the kitchen, however, bubble packs with medication remaining were observed on top of a desk and in a basket underneath the desk next to the medication cabinet. Medications were not reviewed today. During today's visit, LPA discussed the past due annual fees with the Assistant Administrator. LPA will email all invoices to Assistant Administrator, who will work with the licensee to ensure past due fees are paid. The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiency may result in civil penalties. Exit interview conducted. A copy of today's report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 4, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 12:00 p.m., the LPA met with staff and explained the reason for it visit. At 12:20 p.m., the Assistant Administrator Karina Antig arrived at the facility. At 12:30 p.m., the LPA, along with the Assistant Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards. The kitchen, dining area and food storage areas were observed. Kitchen appliances appeared to be in operable condition. At 12:36 p.m., hot water temperature measured at 116.9-degree Fahrenheit. Knives are stored in a locked kitchen cabinet. The facility has a sufficient supply of perishable and non-perishable food. All indoor and outdoor passages were free of obstruction.The fire extinguishers were fully charged and serviced on 05/20/2025. At 12:53 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Medications are centrally stored and in a locked cabinet near the kitchen. Cleaning supplies and items that could pose a danger were secured in a locked cabinet inside the garage. Laundry units are located inside the garage. The front patio has covered seating for resident use. Facility has one (1) fence gate that self-latches for emergency exit use. No bodies of water were observed. There are four (4) resident bedrooms and one (1) staff room in the locked garage. Additionally, there is an upstairs area solely dedicated for staff. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The facility has two (2) resident restrooms. Restrooms were observed to be clean and sanitary with hand soap, toilet paper and paper towels. The hot water temperature in restrooms measured within required range. Due to time constraints the LPA will return to complete the annual at a later date. No deficiencies were cited at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 18, 2025

Allegation investigated: Licensee did not provide resident with copy of Admission Agreement. Licensee did not provided proper notice of rent increase to resident or responsible party.

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced initial complaint visit to this facility. At 9:42 a.m., the LPA met with staff and explained the reason for the visit. At 9:56 a.m., Assistant Administrator Karina Antig arrived at the facility. Starting at 9:56 a.m., the LPA conducted interviews with the Assistant Administrator and one (1) resident. At 10:05 a.m., the LPA conducted a resident record review. At 10:10 a.m., the LPA obtained copies of pertinent documents. At 10:36 a.m., the LPA along with the Assistant Administrator conducted a physical plant tour. Continued on LIC 9099-C. Substantiated Regarding the allegation: Licensee did not provide resident with copy of Admission Agreement. On 08/11/2024, the Department received a complaint alleging that Resident #1’s (R1’s) representative did not receive a copy of the Admission Agreement within the required time frame. Per record review, R1 was admitted to the facility on 03/04/2024 and on 05/29/2024, Assistant Administrator sent the filled-out Admission Agreement to R1’s representative for review and signature via email. The LPA had several conversations with the Assistant Administrator about the importance of reviewing and signing resident records in a timely manner for accuracy and transparency. The Assistant Administrator understood and stated that moving forward all Admission Agreements will be reviewed with residents or resident representative if any and signed and dated no later than seven days following admission. The LPA reminded the Assistant Administrator that the resident or resident representative shall receive a copy of the Admission Agreement immediately upon signing and the original copy of the Admission Agreement shall be retained in the resident’s file. Based on record review and interviews, the preponderance of evidence standard has been met, therefore the above allegations of “Licensee did not provide resident with copy of Admission Agreement” is deemed Substantiated. Regarding the allegation: Licensee did not provided proper notice of rent increase to resident or responsible party. On 08/11/2024, the Department received a complaint alleging that Resident #1’s (R1’s) representative did not receive proper notice of rent increase to resident or responsible party. It was alleged that the rate upon admission was $4,000 however R1’s Admission Agreement listed the rate as $4,500. Per record review, R1 was admitted to the facility on 03/04/2024 and on 05/29/2024, Assistant Administrator sent the filled-out Admission Agreement to R1’s representative for review and signature via email.Due to conflicting information, the LPA could not determine if R1 required a notice for rate/ rent increase. During resident record review, Resident #2’s (R2’s) Admission Agreement, dated 01/23/2020 listed the rate for $4,000 and per interview with Assistant Administrator R2’s rate is now $4,500. The Assistant Administrator stated that the increase took place two years ago. The Assistant Administrator explained that they do not increase the rates/ rents every year and only increase the rates/ rents if necessary. The Assistant Administrator stated that she verbally communicated with R2’s representative about increasing the rate/ rent, however, written notice did not have the required 60 days notice. Per record review and interview, a notice was given for rate/ rent increase to R2's representative however not with the proper time frame. Continued on LIC 9099-C. Based on record review and interviews, the preponderance of evidence standard has been met, therefore the above allegation of “Licensee did not provided proper notice of rent increase to resident or responsible party” is deemed Substantiated. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiencies were observed and cited during the visit (See 9099-D). Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 14, 2024 · control 29-AS-20240811081939

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(c) · Plan of correction due date: Aug 23, 2024

87507(c) Admission Agreements(c) Admission agreements shall be signed and dated, ... or the resident's representative,...& the licensee...no later than seven daysfollowing admission...This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above as R1 admissions agreement was not signed and completed within the required time frame which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 14, 2024

Plan of correction: The Administrator stated that she will submit a statement of understanding and a plan on how the facility will be in compliance with the above regulation by due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655(a) · Plan of correction due date: Aug 23, 2024

1569.655 (a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents...the licensee shall provide no less than 60 days' prior written notice...the amount of the increase...This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the above cited section as the licensee did not provide R2’s representative a proper 60 day notice in writing including the amount of the increase, which poses a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 14, 2024

Plan of correction: The Administrator stated that she will submit a statement of understanding and a plan on how the facility will be in compliance with the above regulation by due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. Upon arrival, there were two staff and four residents present. The Assistant Administrator Karina Antig was contacted over the phone and arrived shortly after the visit began. Entrance interview conducted. At 11:15AM, the LPA, along with Assistant Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: LPA noted the facility to be under construction currently. Notification was sent to the Regional Office (RO) on 05/14/2024 indicating 1 bathroom would be renovated and kitchen flooring replaced. Notification also indicated no major construction required and that the scheduled time frame was 05/13/2024 to 05/25/2024. No extension or change of scope of work was received at the RO as of today's date. LPA discussed with Assistant Administrator sending an updated notification letter, as well as ensuring all required building permits are obtained. BEDROOMS: Typically, there are 4 (four) designated resident rooms and 1 (one) staff room inside the locked garage area, as well as an upstairs area solely dedicated to staff use. At this time, 3 (three) resident rooms are being utilized for resident sleeping use and a vacant resident room is being utilized as a shared common space. LPA observed the 3 (three) resident rooms to contain appropriate linens and furnishings. However, exit doors in all 3 (three) rooms were blocked with storage items, and at least 1 (one) of the doors was observed to be dead bolted shut at the time of the visit. RESTROOMS: The facility contains 2 (two) shared resident restrooms and 1 (one) staff restroom upstairs. The bathrooms were sufficiently stocked with supplies and paper towels. 1 (one) resident restroom was locked and under construction. The hot water temperature was measured in the common hallway restroom at 129.4 degrees Fahrenheit at 11:28AM. Report Continued on LIC 809-C KITCHEN: The kitchen area was observed to be covered in plastic and currently under construction. All appliances have been removed and/or relocated. Beginning at 11:43AM, LPA observed the facility refrigerator to be in the dining room, and containing multiple expired foods, including but not limited to: 4 18-packs of eggs with a use by date of 05/24/2024, Best Foods Mayonnaise with a best before date of 03/10/2024, Tree Top Applesauce with a best buy date of 07/25/2023, grapes and vegetable medley that were observed browned. Additionally, LPA noted multiple plastic storage containers containing leftover foods, which were not labeled nor dated. Assistant Administrator stated that due to the kitchen construction, they are currently utilizing an off-site kitchen to prepare dinner. Lunch and breakfast are prepared by staff either in the facility side yard or in the dining room using small kitchen appliances only. COMMON AREAS: Due to the construction, the living room and dining room are being used as storage areas. The common living room has been relocated to a vacant resident room. 2 (two) fire extinguishers were observed to be fully charged and last serviced 05/14/2024. Front door exit contains a latch at the bottom, and all other remaining common area exits were observed to be blocked and/or locked at the time of the visit. The LPA observed required postings throughout the common space. GARAGE AND GROUNDS: The garage is attached to the house and locked at all times. The laundry room is in the garage locked and inaccessible. Cleaning supplies and disinfectants are kept in locked cabinets in the garage. There is one (1) additional refrigerator and one (1) freezer in the garage with perishable items. Facility has an adequate amount of emergency food and emergency water. Outdoor area was observed to be used as storage and preparation for the construction, so was unable to be properly assessed for compliance. Passageway to the exit gate was observed to be blocked by a table containing small kitchen appliances. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: Not reviewed during today's visit. RECORDS/MEDICATIONS: LPA reviewed 2 (two) resident files during today's visit. LPA observed both residents to be on hospice, however the facility's approved hospice waiver is for 1 (one) hospice resident. Remaining files will be reviewed during the annual continuation visit. Medications were observed to be stored locked; medications were not reviewed today. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. A $500 civil penalty was assessed. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted. A copy of today's report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 4, 2024