The Residence at Dean

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit at 02:00 PM. When the LPA arrived, there was one (1) staff and one (1) resident present and the LPA explained the reason for the visit. Facility Designee Amelia (Mae) Davis arrived shortly thereafter and was explained the reason for the visit. The LPA conducted a tour of the facility. The following was observed:The facility is a single-story residence that consists of four (4) resident bedrooms and three (3) bathrooms. It appears a portion of the garage was converted into a staff room, however, Facility Designee could not confirm if permits or approval were obtained for this construction. Co-Designee Alex Tecson, informed the LPA over the phone that the facility was bought and fire cleared with the room in the garage and it was initially being used as a storage room. Co-Desinee informed the LPA that no one was living in the room, however the LPA observed the room furnished with a bed, clothes, desk, and night stand among other belongings. The fire extinguisher appeared to be fully charged, but was last serviced on 09/15/2025. LPA reminded the Designee the fire extinguisher needs to be re-serviced by 09/15/26. The hardwired smoke and carbon monoxide detectors were tested and functioned properly. LPA observed required postings near the entry. Bedrooms: There were three (3) vacant resident bedrooms and one bedroom with the current resident. The occupied resident bedroom was properly furnished with adequate lighting, and clean bedding. All resident bedrooms have exit doors leading to the outside. LPA observed all four (4) resident bedroom exit doors with two locks, top lock exit doors were locked with key. Report continued on LIC809-C Bathrooms: The LPA observed all bathrooms clean, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. Residents have sufficient amounts of supplies for personal hygiene. The hot water was measured in the communal bathroom during physical plant tour, at 117.3 degrees Fahrenheit, within the required limit of 105-120 degrees Fahrenheit. Laundry Room: The laundry room cabinets were observed to be locked and contain laundry detergent and other chemicals. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility. Sharp objects are stored in a locked drawer to the right of the stove and cleaning supplies are stored in a locked cabinet under the sink. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. The facility maintained a comfortable temperature throughout the visit. Surrounding Grounds (Outdoors): There was a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. Exit gate was observed to be self-closing and self-latching. Garage: The garage is where additional non-perishable emergency food items are held. Cleaning supplies and disinfectants are kept in the garage. The garage is locked and inaccessible to the residents in care. Due to time constraint the LPA will return at a later time to complete the annual. Pursuant to Title 22 of the CA Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D). Civil penalty was assessed. Exit interview conducted and copy of the report and appeal rights were emailed.the state’s words, verbatim · CDSS document, Sep 3, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Sep 4, 2026

87203 Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above in all resident rooms that were observed locked with key which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Designee unlocked all top locks during the visit and agreed to remove all top locks from the doors. Proof needs to be submitted by 09/04/26.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 09:50AM. When the LPA arrived, there were 2 (two) staff and 2 (two) residents present. Facility Designee Amelia (Mae) Davis arrived as facility staff opened the door and greeted the LPA. Beginning at 10:03AM, LPA, along with Facility Designee, conducted a tour of the facility. The following was observed: The facility is a single-story residence that consists of four (4) resident bedrooms and two (2) bathrooms. There is one (1) additional bedroom for staff use that is not identified on the approved fire clearance nor on the facility sketch. It appears a portion of the garage was converted into a staff room, however, Facility Designee could not confirm if permits or approval were obtained for this construction. The fire extinguisher appeared to be fully charged, but was last serviced on 09/06/2024. The hardwired smoke and carbon monoxide detectors were tested at 01:12PM and functioned properly. LPA observed required postings near the entry. Bedrooms: The resident bedrooms were properly furnished with adequate lighting, and clean bedding. Both Resident #1 (R1) and Resident #2 (R2) had half bedrails on their beds, however there were no physician's orders indicating use of postural supports. Bathrooms: The LPA observed one private resident bathroom, one bathroom used by staff, and one shared resident restroom. All bathrooms were clean, properly supplied and had functional fixtures. The LPA observed grab bars and slip-resistant surfaces. Residents have sufficient amounts of supplies for personal hygiene. Facility Designee was advised to secure all personal grooming and hygiene products present in the Report continued on LIC809-C shared resident restroom. The hot water was measured at 117.1 degrees Fahrenheit in the shared resident restroom, which is within the required limit of 105-120 degrees Fahrenheit. Laundry Room: The laundry room cabinets were observed to be locked and contain laundry detergent and other chemicals. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility. Sharp objects are stored in a locked drawer to the right of the stove and cleaning supplies are stored in a locked cabinet under the sink. Upon arrival, LPA noted the drawer to be unlocked. LPA advised to keep the drawer locked at all times if any residents are at risk with access to any items stored inside. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. The facility maintained a comfortable temperature throughout the visit. Surrounding Grounds (Outdoors): There was a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. Exit gate was observed to be self-closing and self-latching. Garage: The garage is where additional non-perishable emergency food items are held. Cleaning supplies and disinfectants are kept in the garage. The garage is locked and inaccessible to the residents in care. Facility designee indicated the facility does not have emergency water. File review: Began at 10:20AM. LPA reviewed both residents' files. Resident #2 (R2) was admitted to hospice care on 04/01/2025, however no notification was sent to CCLD as required. LPA reviewed personnel files for 4 (four) staff, including Administrator. The Administrator has not been present at any CCLD visits observed in the facility's history, since the pre-licensing visit in 2022. LPA obtained a copy of the facility's LIC 500, which indicates Administrator is present Monday - Friday 09:00AM to 01:00PM, however was again unavailable during today's visit. Administrator did not have a full and complete file for review at the facility, nor was Administrator able to bring a copy to the facility during today's visit. Administrator is missing a health screening, results from a tuberculosis test, first aid/CPR training, and personnel report. Staff #1 (S1) has been working at the facility for at least 2 months and does have a fingerprint background clearance, however was not associated to this facility. S1 also does not have a health screening or results of a tuberculosis test Report Continued on LIC 809-C on file at this location. None of the 4 (four) staff files reviewed contained proof of the required annual medication training. Additionally, both the Administrator and Staff #2 (S2) did not have proof of CPR nor first aid training. S2 works alone during the overnight shift. Emergency Disaster Plan/Infection Control: The LPA reviewed the facility's Infection Control Plan, Disaster Plan and evacuation drills. Emergency Disaster plan has not been updated since 2022 and contains outdated information. Infection control plan appeared to be complete and updated annually as required. Emergency disaster drills are conducted quarterly, with the last evacuation drill documented on 06/08/2025. Interviews: LPA conducted interviews with 2 (two) residents and 2 (two) staff. No immediate concerns were voiced during the visit. Medication audit: Medications were reviewed beginning at 12:30PM. Medications are centrally stored and locked in a cabinet in the common area. LPA observed medications to be prepared for a 2-week time period, with 9 (nine) days remaining in the pre-prepared medication boxes. Centrally Stored Medication and Destruction Records (CSMDR) for both residents were reviewed and compared to medications present. However, start dates were incorrect as well as refill information and prescription numbers were illegible. Medication start dates were written in including dates in the future. It's possible this is due to the medications being prepared well in advance and improperly stored, however start dates could not have been correct based on medication counts. A complete medication audit was unable to be completed at this time due to the improper storage and documentation. LPA also observed that R1 has over the counter medications, including Bayer Aspirin, Vitamin D3, Centrum Women 50+, and Vitamin C, which were not labeled nor were there prescription orders for these medications. No PRN authorization forms were present for either resident. Pursuant to Title 22 of the CA Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D). 2 (two) civil penalties were assessed, each for $500. Exit interview conducted and copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 12, 2025

The state marks this report as 14 pages; the online copy we transcribed has 10. You can request the full file from the county licensing office.

Allegation investigated: Licensee did not refund resident's estate upon death Facility representative did not report resident's change in condition

Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation with the purpose of delivering findings for the above noted allegations. LPA initially met with facility staff and explained the reason for the visit. Facility Designee Amelia (Mae) Davis arrived at 02:25PM. Entrance interview conducted. During an initial complaint visit conducted on 02/12/2025, LPA toured the facility with staff at 02:17PM, interviewed staff at 02:23PM, interviewed Facility Designee at 02:44PM, and interviewed Facility Designee Alex Tecson telephonically at 02:54PM. LPA reviewed and obtained copies of documents relevant to the investigation and requested additional documents be sent to LPA via email. Throughout the course of the investigation, LPA interviewed and attempted to interview other relevant parties telephonically and LPA reviewed all documents obtained. The following was then determined: Report Continued on LIC 9099-C Unsubstantiated Allegation “Licensee did not refund resident’s estate upon death:” The complaint alleges that Resident #1 (R1) paid a lump sum when moving into the facility and R1’s estate was not refunded the unused balance upon R1’s death. LPA inquired about the facility’s refund policy and Facility Designee indicated the policy depends on what is written in the resident’s admission agreement. LPA reviewed R1’s admission agreement, which states “in the event of resident’s death, the monthly charges paid in advance will not be refunded once the resident is admitted to hospice care.” Admit date on the admission agreement is listed as 12/12/2022, however hospital discharge paperwork indicates R1 was to be discharged to their previous residence on this date. Staff interviewed stated that R1 only resided at the facility for a few days before R1 passed away, however, hospice paperwork reviewed contained notes for R1’s care from 12/12/2022 through 01/03/2023. No death report was received at the Woodland Hills Regional Office (RO,) therefore, it is unclear exactly which date R1 passed away. Interview with facility designee revealed that someone from the county came to retrieve R1’s personal belongings following R1’s death. LPA asked for a written record of belongings the county representative took from the facility, however, facility designee stated no such record exists. Facility designee could not recall which date R1’s belongings were removed from the facility. Although R1 was admitted to hospice care and R1’s admission agreement indicates no refunds will be issued if a resident is admitted to hospice care, health and safety code 1569.652 requires that a refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the resident’s estate. However, facility representatives interviewed could not recall the date R1 died nor the date R1’s belongings were removed and there is no written record indicating either date. A copy of a check written to the facility in the amount of $7500 was found in R1's file. The monthly fee as written in R1's admission agreement was $7500. Licensee representative indicated the check was to pay for 1 (one) month. Even though staff interviewed stated R1 only lived at the facility for days not weeks, it is unclear which date R1 moved into the facility, when R1 passed away and the date their belongings were removed from the facility. Therefore, the LPA cannot determine the amount of refund (if any) due to R1’s estate. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. Report Continued on LIC 9099-C (p. 3) Allegation “Facility representative did not report resident’s change in condition:” The complaint alleges that Resident #2 (R2) experienced a decline, which was not reported to R2’s outside health care provider. Interview with facility staff revealed that when a resident experiences any change, including a decline in their health status, facility staff contact all relevant parties telephonically, including the resident’s family, primary physician, and any outside health care provider(s.) Related to R2, facility staff stated they did report to R2’s hospice verbally and the family was present with R2 daily. Documents reviewed did not indicate a change of condition; the last entry on R2’s care/flow sheet on 12/18/2023 indicated R2 was in need of a podiatrist visit at that time, but “no other significant changes to report.” Additionally, LPA reviewed documents sent to the RO from the facility and discovered that no written incident report nor death report were sent to the RO related to R2. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. Deficiencies observed not related to the allegations above will be addressed during a case management visit. No deficiencies cited related to this complaint. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 24, 2025 · control 29-AS-20250207101708

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kelly Dulek conducted case management visit to address deficiencies observed during the course of an unrelated complaint investigation. LPA initially met with facility staff and explained the reason for the visit. Facility Designee Amelia (Mae) Davis arrived at 02:25PM. Entrance interview conducted. During a visit at the facility on 02/12/2025, LPA noticed an injury to Resident #1 (R1)’s face and upper body. LPA inquired with staff as to how R1 sustained the injury. Staff interviewed stated that R1 had fallen while at the facility and had received outside medical treatment for R1’s injuries. After R1’s fall, staff had rearranged R1’s furniture in their room to help prevent further injury. During file review, LPA reviewed records for Resident #2 (R2) who passed away in early 2023. LPA reviewed all unusual injury/incident reports sent to the Woodland Hills North Regional Office (RO) and noted that 0 (zero) incident reports and 0 (zero) death reports have been received at the RO since the date the facility was licensed on 09/06/2022. LPA interviewed facility designee, who stated that death reports were sent via email to the RO, however facility designee was unaware that injuries to residents needed to be reported in writing to the RO, so those had not been sent. LPA reminded facility designee of the requirement to send reports for all incidents that threaten the health or welfare of any resident in care within 7 days of any such occurrence. Additionally, while interviewing staff and reviewing documents for R2, it was discovered that the facility was safeguarding R2’s items, such as R2’s wallet, including at least $500 cash, debit card, and green card. The facility did not maintain a LIC 621 for R2. Additionally, when R2 passed away and R2’s belongings were removed from the facility, the licensee did not sign or indicate R2’s items were removed. R2’s admission agreement indicates no refund will be issued following the death of any resident receiving hospice services. Report Continued on LIC 809-C However, health and safety code requires a refund to be issued to all residents’ families/estates, regardless of receiving end of life care. LPA also noted that the facility’s admission agreement does not follow the title 22 requirements related to pre-admission policy and refunds. Pursuant to Title 22 of the CA Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Jul 24, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Aug 7, 2025

87211 Reporting Requirements (a) (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events...if any; and disposition of the case. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the above cited section, as no incident or death reports from the date of licensure to the present time have been received at CCLand there were at least 2 (two) deaths and a fall incident, which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 24, 2025

Plan of correction: Facility designee agreed to ensure all incident and death reports are submitted timely. A statement of understanding of the section related to reporting requirements will be signed by Administrator, Licensee representatives, and all facility designees and sent to CCL by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87217(j) · Plan of correction due date: Aug 7, 2025

87217 Safeguards for Resident Cash, Personal Property, and Valuables (j) Upon the death of a resident, all cash resources, personal property, and valuables of that resident shall immediately be safeguarded. 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 R1 did not have a record of any items brought into the facility, nor were items safeguarded or documented upon R1's death, which posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 24, 2025

Plan of correction: Facility Designee agreed to ensure residents' belongings are inventoried upon move in and safeguarded at the facility. A statement of understanding of this regulation section will be signed and sent to CCL by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(5)(A) · Plan of correction due date: Aug 7, 2025

87507 Admission Agreements (g) (5) (A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the above cited section, as the facility's Admission Agreement states residents on hospice care will not receive a refund, which is not allowed per regulation and poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 24, 2025

Plan of correction: Facility Designee agreed to discuss with Licensee Representative. Admission Agreement will be modified and sent to CCL for approval by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual visit at 10:15 a.m. When the LPA arrived, there was one staff and four residents present. The LPA was greeted by a caregiver staff 1 (S1) and informed them of the reason for the visit. Back-up Administrator Mae Davis arrived shortly after S1 called. The back-up administrator works at the licensee's other facilities. At 10:18 a.m. LPA conducted a tour of the facility and conducted interviews during the physical plant tour. The facility is a single-story residence that consists of four (4) resident bedrooms and two (2) bathrooms. There is one (1) additional bedroom for staff use. The fire extinguisher was last serviced on 9/15/2023 and appeared fully charged. The smoke and carbon monoxide detectors were tested and functioned properly. LPA observed required postings near the entry. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility; Sharp objects are stored in a locked drawer to the right of the stove and cleaning supplies are stored in a locked cabinet under the sink. LPA observed the cabinet storing cleaning supplies was unlocked and unsupervised. Bedrooms: The resident bedrooms were properly furnished with adequate lighting, and clean bedding. Bathrooms: The LPA observed one private resident bathroom, one bathroom used by staff, and one bathroom used by the three other residents. All bathrooms were clean, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats. Residents have sufficient amounts of supplies for personal hygiene. The hot water was measured at 112.5*F in the private bathroom and 114.9*F in the other resident bathroom which is within the required limit of 105-120 degrees Fahrenheit. LPA observed in the staff bathroom there were cleaning supplies such as bleach stored in an unlocked cabinet under the sink. (continued on LIC809-C (continued from LIC809) Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. The facility maintained a comfortable temperature of approximately 72 degrees. Garage: The garage is where additional non-perishable emergency food items are held. Cleaning supplies and disinfectants are kept in the garage. The garage is locked and inaccessible to the residents in care. Laundry Room: The laundry room cabinets were observed to be unlocked with the laundry detergent accessible. Surrounding Grounds (Outdoors): There was a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. File review: LPA reviewed administrator and staff files which were complete, including training. The administrator was off-site during LPA's visit but sent LPA documents that were requested by text and email during the visit. S1 is a new caregiver at this facility. S1 was not fingerprint cleared or associated to this facility; nor did S1 have a health screening on file. S1 stated they work as a private in-home caregiver and had fingerprint clearance but it did not show up in the CCL system. S1 stated this is their fourth day working at the facility. The back-up administrator called for another staff to relieve S1 until S1 can get cleared and associated to this facility. LPA reviewed all four residents' files which were complete. The LPA reviewed the facility's Infection Control Plan, Disaster Plan and evacuation drills. Interviews: LPA conducted interviews with two residents and one staff. No immediate concerns were voiced during the visit. Medication audit: Medications were reviewed. Medications are centrally stored and locked in a cabinet in the common area; medications are labeled and checked for expiration dates. The Centrally Stored Medication and Destruction Records were completed. Medications appeared to be given as prescribed. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 5, 2024