Bernadette Home Care V

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit at 10:05 AM. LPA met with facility staff who contacted the facility Administrator Michelle Racan and the reason for the visit was explained. Administrator arrived shortly thereafter. Entrance interview conducted and reason for the visit was explained to staff and Administrator. RECORD REVIEW: The LPA initiated the annual with Record Review. The LPA reviewed documentation of Insurance Liability, Infection Control, Emergency Disaster Plan and the facility’s last emergency disaster drill was conducted on 08/07/2026. The LPA reviewed four (4) out of four (4) resident files and five (5) out of ten (10) staff files for but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. All records were complete and current. The LPA, along with administrator Michelle Racan toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secure cabinet located under the kitchen sink to contain cleaning supplies and knives. LPA observed an additional fire extinguisher mounted in the kitchen to be fully charged and serviced on 08/15/2026. Continued on LIC 809C, 2nd page. COMMON AREAS: This includes the living room, hallway, and dining room. LPA observed all common areas be clean and properly furnished at the time of the visit. The dining room contains a dining table with adequate seating for resident use. LPA observed the dining room to contain two (2) secured cabinets which contained resident medications and facility files. LPA observed the living room wall to contain all required postings. The living room contained adequate seating and activities for resident use. LPA observed the living room to contain an appropriately screened fireplace. The facility’s fire and carbon monoxide alarms were tested and were functional at the time of the visit. BEDROOMS: There are four (4) resident single occupancy bedrooms in the facility. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. BATHROOMS: There are three (3) bathrooms in the facility. Two (2) bathrooms are designated as private resident bathrooms, and one (1) bathroom is designated as a shared resident bathroom. All resident bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in all resident showers all were properly secured. The water temperature was measured between 112.5 and 113 degrees Fahrenheit. GARAGE: LPA observed the garage to be locked and inaccessible to clients in care. The garage was observed to contain cleaning supplies, extra care supplies, adequate emergency food and water supplies, an extra refrigerator, and the facility’s washer and dryer. OUTDOOR SPACE: The facility has two (2) emergency exit gates leading to the front yard of the facility. LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed a secured storage shed. No bodies of water were observed. MEDICATION REVIEW: LPA conducted a medication review for two (2) residents and the following was observed: Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed. INTERVIEWS: LPA attempted to interview two (2) residents, however they were sleeping. Exit interview conducted and copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 1, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff hit resident in care

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced subsequent complaint visit to investigate the allegation listed above. Upon arrival LPA met with staff and explained the reason for the visit. Administrators Allan Racan and Bernadette Abiera arrived shortly thereafter and where explained the reason for their visit. Entrance interview conducted. On 05/28/2025, starting at approx 12:15pm, the LPA conducted physical plant tour to ensure there are no immediate health and safety concerns, interviewed Administrator Michelle Racan, two (2) staff, two (2) witnesses, three (3) residents, attempted to interview a fourth resident, and reviewed and obtained copies of pertinent documentation relevant to the investigation. On 12/17/25, the LPA conducted a phone interview with one (1) witness. During today's visit the LPA conducted a physical plant tour, file review and obtained copies of pertinent documentation relevant to the investigation. Report will continue on LIC909-C, 2nd page. Unsubstantiated Regarding the allegation of “Staff hit resident in care”; it is the concern of the Reporting Parties (RP’s) that on 05/19/25, Witness 1 (W1) heard Resident 1 (R1) scream in pain three (3) times from inside the bathroom where R1 was with Staff 1 (S1). When R1 and S1 came out of the restroom, W1 asked what happened and it is alleged R1 stated S1 hit them on the head. No injuries were reported. During the initial complaint visit the LPA could not interview R1 as R1 had been moved out of the facility. However, interview with W1 revealed that R1 did not recall the incident later in the day of the alleged day it happened and confirmed that they heard R1 scream three times from the bathroom. When asked what happened R1 stated S1 had hit them. W1 also revealed that no one else witnessed the incident and another staff member was at the facility but not near the restroom to hear the incident. Interview with Administrator Michelle Racan revealed that S1 did not have any history of reported allegations against them, they have never witnessed S1, or any other staff hit a resident and that after the incident had been reported to them, they placed S1 on suspension. S1 was not present at the facility during initial and subsequent complaint visits. During today’s visit, facility representative Bernadette Abiera revealed that after S1 was placed on a two-week suspension they never returned to the facility. File review revealed that S1 was given a memo where they were notified, they were placed on a two-week suspension due to the investigation of the incident. Memo is dated 05/21/2025 and signed by both S1 and Administrator Michelle Racan. The LPA did not observe any other suspension or corrective action for S1 on file. Furthermore, file review revealed that S1 wrote an incident report, dated 05/19/2025, on their accounts of what happened. S1 wrote that R1 had been agitated in the morning and later around 10:00 a.m. they accompanied R1 to the bathroom and while S1 removed/pulled down R1’s pants, shirt and diaper they whimpered and S1 thought R1 was still agitated. Once R1 was done, S1 cleaned them and put back their pants, diaper, and shirt and R1 whimpered again. While going back to the couch, W1 approached them asking “what’s happening” and R1 told them that they were knocked on the head by S1 and S1 denied doing so. Lastly, S1 wrote that hurting a patient is something that they will never do. Interviews with Administrator Michelle Racan, three (3) residents, two (2) staff and two (2) witnesses revealed that no one has ever witnessed any staff member hit a resident. Although the allegation may have happened or is valid, based on the information gathered the department does not have sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation, ‘Staff hit resident in care” is UNSUBSTANTIATED at this time. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Dec 17, 2025 · control 29-AS-20250523132825

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit at 09:20 AM. LPA met with facility staff who contacted the facility Co-administrator Michelle Racan and the reason for the visit was explained. Licensee Representatives Bernadette Abiera and Janette Villapando were present for the visit, however they left before the visit ended. Administrator Allan Racan arrived at the facility at approximately 10:30 a.m. Entrance interview conducted and reason for the visit was explained to staff and Administrators. The LPA, along with co-administrator Bernadette Abiera toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secure cabinet located under the kitchen sink to contain cleaning supplies and knives. LPA observed an additional fire extinguisher mounted in the kitchen to be fully charged and serviced on 08/15/2025. COMMON AREAS: This includes the living room, hallway, and dining room. LPA observed all common areas be clean and properly furnished at the time of the visit. The dining room contains a dining table with adequate seating for resident use. LPA observed the dining room to contain two (2) secured cabinets which contained resident medications and facility files. LPA observed the living room wall to contain all required postings. . Continued on LIC 809C, 2nd page. The living room contained adequate seating and activities for resident use. LPA observed the living room to contain an appropriately screened fireplace. The facility’s fire and carbon monoxide alarms were tested and were functional at the time of the visit. BEDROOMS: There are four (4) resident single occupancy bedrooms in the facility; of which one is vacant.. Bedroom number one (1) is designated as the facility’s bedridden approved room. LPA and facility staff toured all four (4) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Four (4) resident beds were observed to contain full bed rails. At 10:17 a.m. the LPA observed bedroom number one being used as a passage way to a storage/closet inside. At approximately 3:00 p.m. the LPA observed bedroom number one being used as a passage way to a storage/closet inside again. BATHROOMS: There are three (3) bathrooms in the facility. Two (2) bathrooms are designated as private resident bathrooms, and one (1) bathroom is designated as a shared resident bathroom. All resident bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in all resident showers all were properly secured. The water temperature was measured between 107.2 and 109 degrees Fahrenheit, water temperature was adjusted during the visit.. GARAGE: LPA observed the garage to be locked and inaccessible to clients in care. The garage was observed to contain cleaning supplies, extra care supplies, adequate emergency food and water supplies, an extra refrigerator, and the facility’s washer and dryer. OUTDOOR SPACE: The facility has two (2) emergency exit gates leading to the front yard of the facility. LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed a secured storage shed. No bodies of water were observed. RECORD REVIEW: Record review began at 10:52 AM. The LPA reviewed documentation of Infection Control, Emergency Disaster Plan and the facility’s last emergency disaster drill was conducted on 07/09/2025. Three (3) resident and Five (5) staff files were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. All records were complete and current. Report will continue on LIC809-C, 3rd page. MEDICATION REVIEW: LPA conducted a medication review for two (2) of three (3) residents and the following was observed: All medications were stored properly inaccessible to residents in care. During Resident #1 (R#1's) audit, the LPA observed zinc oxide paste skin protectant, silicone cream, menthol-zinc oxide .44-20 ointment without a prescription. Per Administrator Allan they are used on R1. LPA observed two unopened prescribed antifungal 2% miconazole nitrate cream tubes (with 9/29/25 filled date) and not documented on the Centrally Stored Medication and Destruction Record (CSMDR), and two unopen Calprotect 0.44-20.6% tubes with filled dates of 7/07/25 and 09/07/25. LPA observed the menthol-zinc oxide .44-20 ointment not documented on the CSMDR. The LPA observed Amlodipine besylate 10mg with a start date of 10/8, per MAR given at 8am, only 2 missing, based on count and start date, medication was not given as prescribed. During Resident #2 (R#2's) audit, the LPA observed Lamotrigine 25mg with a start date of 10/9/25 and only only 1 missing for morning bubble pack based on count and start date medication was not administered as prescribed. The LPA did not observed start dates for R2's potassium chloride and zonisamide INTERVIEWS: LPA attempted to interview two (2) residents, however they were unable or unwilling to be interviewed. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights providedthe state’s words, verbatim · CDSS document, Oct 10, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 10:06 AM. LPA met with facility staff who contacted the facility administrator Michelle Racan. The administrator arrived to the facility at 10:56 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:09 AM, the LPA, along with facility staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: This includes the living room, hallway, and dining room. LPA observed the dining room to be clean and properly furnished at the time of the visit. The dining room contains a dining table with adequate seating for resident use. LPA observed the dining room to contain two (2) secured cabinets which contained resident medications and facility files. LPA observed the living room wall to contain all required postings. The living room was observed to be clean and in good repair. LPA observed a fire extinguisher mounted in the living room to be fully charged and serviced on 08/15/2024. The living room contained adequate seating and activities for resident use. LPA observed the living room to contain an appropriately screened fireplace. LPA observed a hallway closet to contain first aid supplies and extra care supplies. The facility’s fire and carbon monoxide alarms were tested at 10:50 AM and were functional at the time of the visit. KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured cabinet to contain knives. LPA observed a secure cabinet located under the kitchen sink to contain cleaning supplies. LPA observed an additional fire extinguisher mounted in the kitchen to be fully charged and serviced on 08/15/2024. Continued on LIC 809C. GARAGE: LPA observed the garage to be locked and inaccessible to clients in care. The garage was observed to contain cleaning supplies, extra care supplies, adequate emergency food and water supplies, an extra refrigerator, and the facility’s washer and dryer. OUTDOOR SPACE: The facility has two (2) emergency exit gates leading to the front yard of the facility. LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed a secured storage shed to contain extra wheelchairs and household supplies. All exits to the exterior of the facility contained auditory alarms and all were functional at the time of the visit. BEDROOMS: There are four (4) bedrooms in the facility; two (2) are dual occupancy rooms and two (2) are single occupancy rooms. Bedroom number one (1) is designated as the facility’s bedridden approved room. LPA and facility staff toured all four (4) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Four (4) resident beds were observed to contain full bed rails. BATHROOMS: There are three (3) bathrooms in the facility. Two (2) bathrooms are designated as private resident bathrooms, and one (1) bathroom is designated as a shared resident bathroom. All resident bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in all resident showers all were properly secured. The water temperature was measured between 116.4 and 118.4 degrees Fahrenheit, which is in compliance with regulation. At 10:31 AM LPA observed bathroom one (1) to contain an unsecured pair of green handled scissors making them accessible to residents in care. RECORD REVIEW: Record review began at 10:58 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Five (5) staff files were reviewed. All staff files contained the required documents and trainings. Five (5) resident files were reviewed all resident files contained all required documentation and signatures. No deficiencies were observed during record review. Continued on LIC 809C. MEDICATION REVIEW: Medication review began at 12:10 PM. Medications for three (3) of five (5) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 09/25/2024. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s administrator. INTERVIEWS: LPA interviewed two (2) staff members. Both staff interviewed understood their roles and responsibilities, The resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. LPA attempted to interview the facility’s residents, but all residents were unable/unwilling to speak with the LPA. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 24, 2024

Allegation investigated: Facility staff punch resident Facility staff are not properly supervising residents who may be a fall risk

Licensing Program Analyst (LPA) Esther Cortez conducted an initial 10-day complaint visit. At 10:15 a.m. the LPA met with staff and explained the reason of the vist. At 11:10 a.m. co administrator Michelle Racan arrived, and at 12:03 p.m. Administrator Alan Racan arrived at the facility. During today's visit the LPA toured the facility with staff, conducted three (3) resident interviews, reviewed files, and conducted interviews with the Administrator and Co-Administrator. Report will continue on LIC9099-C. Unfounded On 8/12/2024, the Department received a complaint alleging that Facility staff punch Resident and that staff are not properly supervising residents who may be a fall risk. It is the concern of the reporting party that staff punched Resident #1 (R1), and that R1 fell off their bed and staff did not come to assist them. During today's visit, the LPA, conducted a tour of the facility, interviewed three (3) residents, interviewed facility Administrator and co-administrator and obtained a copy of the facility's resident roster. Administrator's Interviews and review of roster revealed that Resident #1, whom the complaint is in reference to, does not reside at this facility. Based on the information obtained, the allegation is deemed UNFOUNDED at this time. A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 19, 2024 · control 29-AS-20240812160642