Happy Home Care 3

Allegation investigated: Staff did not ensure resident calls for assistance were answered in a timely manner Licensee does not ensure facility staff are awake at all times Staff does not ensure facility phone calls are answered in a timely manner Staff does not ensure facility is free of obstructions Staff does not respond to call pendant alerts in a timely manner

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent complaint visit to investigate the above-listed allegations. The purpose of this visit is to investigate and deliver findings for the above listed allegations. Upon arrival at approx. 10:00 a.m. LPA was greeted by staff who called the Administrator and the reason for the visit was explained. The LPA met with Karina Antig, Facility Designee (FD), and reason for the visit was explained. Entrance interview conducted. On 05/28/2026, the Department received a complaint regarding the following allegations, Staff did not ensure resident calls for assistance were answered in a timely manner, Licensee does not ensure facility staff are awake at all times, Staff does not ensure facility phone calls are answered in a timely manner, Staff does not ensure facility is free of obstructions and Staff does not respond to call pendant alerts in a timely manner. Report continued on LIC 9099-C PAGE 2... Substantiated (PAGE 2) Report continued from LIC 9099... On 05/28/2026 LPA Mosley and Adult Protective Services (APS) Julie Carroll conducted a joint unannounced initial 10-day complaint visit at approx. 3:00 p.m. Starting at 3:05 p.m. LPA, APS, and FD toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, and facility is in compliance with Title 22 Regulations. Starting at 3:26 p.m. and throughout the visit LPA and APS conducted interviews with two (2) residents and two (2) staff a file and record review for Resident #1 (R1) and obtained copies of pertinent documents relevant to the investigation. During todays visit starting at 10:06 a.m. LPA and staff toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, and facility is in compliance with Title 22 Regulations. On the allegations, Staff did not ensure resident calls for assistance were answered in a timely manner, Staff does not respond to call pendant alerts in a timely manner and Staff does not ensure facility phone calls are answered in a timely manner It is the Reporting Party’s (RP) concern that facility staff did not respond to phone calls from emergency personnel, nor to Resident #2’s (R2’s) calls for assistance—both verbal and via the call button—on 05/27/2026, when Resident #1 (R1) had fallen and was on the floor. To investigate this complaint, LPA conducted interviews with staff and residents, file and record review, and obtained copies of pertinent documentation relevant to the investigation. Interview with R1 revealed that they are unable to recall specific details or provide a reliable source of information due to cognitive impairment. Interview with R2 revealed that on 05/27/2026, during the night/early morning, they were in their shared room with R1. R2 reported hearing R1 making noises and observed R1 on the floor. R2 stated they needed assistance from staff and wished to be repositioned. R2 began shouting for staff, calling out “Help” and “John.” R2 also pressed their pendant multiple times; however, no staff responded. R2 expressed becoming worried because R1 was on the floor between their beds and making grunting noises. R2 called for staff but did not see any staff present and was unable to assist R1 on their own. R2 stated they called out for staff assistance for approximately two (2) hours before deciding to call 911. R2 contacted 911 for assistance and to ensure R1’s safety after being unable to obtain help from staff. During that time the facility phone was ringing however the staff did not respond to that either. Report continued on LIC 9099-C PAGE 3... (PAGE 3) Report continued from LIC 9099 PAGE 2... Paramedics arrived at the facility at approximately 6:20 a.m. Access to the home was obtained through forced entry after attempts to make contact were unsuccessful. It was noted that the paramedics made multiple phone calls to the facility that went unanswered. Interview with Staff #1 (S1) revealed that on the morning of 05/27/2026, during the approximate time frame of 4:00 a.m. to 6:00 a.m., the incident occurred while S1 was the on-duty staff. S1 reported that they last physically observed R1 and R2 around 4:00 a.m. during a routine night check. S1 stated they were performing routine cleaning tasks, first in the laundry room and then in the bathroom. S1 reported that when paramedics arrived at the facility, they were in the bathroom showering and heard a noise. S1 stated that during this time frame, they did not hear any call button alerts. S1 also stated they had informed R2 that they would begin preparing, cleaning, and showering and would be unavailable during that period. S1 noted that R2 frequently uses their call button approximately every twenty (20) minutes for non-emergency requests. Additionally, S1 stated that they check on the residents every two (2) hours during the night hours. Record review revealed that on 05/27/2026 at approximately 6:20 a.m., paramedics arrived at the facility after R2 called for assistance because R1 had fallen. Paramedics arrived at the facility at approximately 6:20 a.m. Access to the home was obtained through forced entry after attempts to make contact were unsuccessful. It was noted that the paramedics made multiple phone calls to the facility that went unanswered. Based on information gathered during the course of the investigation there is sufficient evidence to support the allegations occurred. Therefore, the allegations of Staff did not ensure resident calls for assistance were answered in a timely manner, Staff does not respond to call pendant alerts in a timely manner and Staff does not ensure facility phone calls are answered in a timely manner are deemed SUBSTANTIATED at this time. On the allegation, Licensee does not ensure facility staff are awake at all times It is the concern of the RP that facility staff were unavailable during an emergency. To investigate this complaint, LPA conducted interviews with staff and residents, file and record review, and obtained copies of pertinent documentation relevant to the investigation. Interview with R1 revealed that they are unable to recall specific details or provide a reliable source of information due to cognitive impairment. Report continued on LIC 9099-C PAGE 4... (PAGE 4) Report continued from LIC 9099 PAGE 3.. Interview with R2 revealed that on 05/27/2026, during the night/early morning, they were in their shared room with R1. R2 reported hearing R1 making noises and observed R1 on the floor. R2 stated they needed assistance from staff and wished to be repositioned. R2 began shouting for staff, calling out “Help” and “John.” R2 also pressed their pendant multiple times; however, no staff responded. R2 expressed becoming worried because R1 was on the floor between their beds and making grunting noises. R2 called for staff but did not see any staff present and was unable to assist R1 on their own. R2 stated they called out for staff assistance for approximately two (2) hours before deciding to call 911. R2 contacted 911 for assistance and to ensure R1’s safety after being unable to obtain help from staff. During that time the facility phone was ringing, however the staff did not respond to that either. Paramedics arrived at the facility at approximately 6:20 a.m. Access to the home was obtained through forced entry after attempts to make contact were unsuccessful. It was noted that the paramedics made multiple phone calls to the facility that went unanswered. During this time the staff were unavailable and unaware of the emergency with R1. Interview with Staff #1 (S1) revealed that on the morning of 05/27/2026, during the approximate time frame of 4:00 a.m. to 6:00 a.m., the incident occurred while S1 was the on-duty staff. S1 reported that they last physically observed R1 and R2 around 4:00 a.m. during a routine night check. S1 stated they were performing routine cleaning tasks, first in the laundry room and then in the bathroom. S1 reported that when paramedics arrived at the facility, they were in the bathroom showering and heard a noise. S1 stated that they always have a staff awake at night and are always available to residents. Based on information gathered during the course of the investigation there is sufficient evidence to support the allegation occurred. Therefore, the allegation of Licensee does not ensure facility staff are awake at all times is deemed SUBSTANTIATED at this time. Report continued on LIC 9099-C PAGE 5... (PAGE 5) Report continued from LIC 9099 PAGE 4.. On the allegation, Staff does not ensure facility is free of obstructions, it is the concern of the RP that the facility had multiple obstructions, including multiple locks and exterior doors being locked during an emergency. To investigate this complaint, LPA conducted a physical plant tour on 05/28/2026, took photos of the front door and exit doors and obtained copies of pertinent documentation relevant to the investigation. During the physical plant tour on 05/28/2026, LPA discovered a bolt lock on the inside of the facility’s main door, and both exterior exit doors were locked. At the time of the visit, the facility removed the bolt lock, and both exterior doors were unlocked. The LPA and facility designee discussed the importance of keeping exterior doors unlocked. The facility designee informed the LPA that an in-service training was conducted on 05/28/2026 from 9:30 a.m. to 10:30 a.m. with staff regarding residents having access to exits. LPA obtained a copy of the training. Based on information gathered during the course of the investigation there is sufficient evidence to support the allegation occurred. Therefore, the allegation of Staff does not ensure facility is free of obstructions is deemed SUBSTANTIATED at this time. An immediate civil penalty in the amount of $1,000 was assessed for a violation of the facility’s fire clearance (Refer to LIC 421M) and is being assessed as a repeat violation for the same violation that was cited on 11/07/2025. The Licensee was advised that failure to correct may result in additional civil penalties. Pursuant to Title 22 CA Code of Regulations and/or the Health and Safety Code, the following deficiency was cited (Refer to 9099-D). Exit interview conducted. A copy of the appeal rights and report was reviewed and provided.the state’s words, verbatim · CDSS document, Jul 1, 2026 · control 29-AS-20260528120953

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Jul 2, 2026

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet residents’ needs. … This requirement was as R2 was forced to call 911 for assistance due to staff not being available to respond. Additionally, this requirement was not met by the lack of staff response to multiple call button activations, which resulted in the resident calling 911 and emergency personnel arriving and being unable to reach the facility by phone which poses an immediate safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: The Administrator will train all staff on responding to call buttons, calls for assistance, and facility phone calls, and will develop written procedures for these responsibilities, including overnight procedures by POC 07/10/2026. Administrator will submit a statement of understanding to CCL regarding responding to call buttons, calls for assistance, and facility phone calls and regulation - 87411 Personnel Requirements by 07/02/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Jul 2, 2026

(a) All facilities shall maintain a fire clearance approved ... licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, ...This requirement was not met as evidenced by: Based on observation the licensee did not comply with the regulation above the front entry door had bolt lock and the two (2) outdoor exit doors were locked which poses an immediate safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: Facility designee removed the bolt lock and unlocked the two (2) exterior doors at the time of the visit and conducted an in-service training with staff regarding the regulation on 05/28/2026 at 9:30- 10:30 a.m. Administrator will submit a statement of understanding to CCL regarding not having locks on doors or locking exterior doors by POC due date 07/02/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jul 2, 2026

(f)Basic services shall at a minimum include:(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by Based on interviews the Licensee did not comply with the regulation above in the staff on duty was unavailable and in the shower during an emergency and resident had to call 911 for assistance which poses an immediate safety risk to residents in carethe state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: The Administrator agrees to re-train all awake night staff in accordance with the facility’s Plan of Operation, including conducting an in-service training on overnight procedures by 07/10/2026. The Administrator will also develop, update, and submit the facility’s current overnight procedures to CCL by the POC due date 07/02/2026.In addition, the Administrator will submit the current LIC 500 to CCL as required.07/02/2026 (submitted)

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 10 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrators Karen Rosales and Karina Antig arrived shortly after and the reason for the visit was explained. Entrance interview. The LPA and 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. INTERVIEWS: Starting at 10:08 a.m. and throughout the visit one (1) staff and four (4) resident interviews were conducted. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. COMMON AREAS: This includes the family room, living room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The walls in the living room and dining room were in disrepair with cracks, wilts and paint chipping. The LPA informed the Administrator that the walls must be repaired. The facility maintained a comfortable temperature. At 3:16 p.m., hardwire combination of smoke / carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 05/20/2025. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 10/11/2025 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... There is a functioning telephone on the premises. The auditory alarms at the front door entrance and sliding door exit located in the family room were observed to be turned off the time of the visit, LPA advised the Administrator that they need to be functional at all times. Both alarms were turned on and functioned properly at the time of the visit. BEDROOMS: There are five (5) total resident bedrooms in the facility; four (4) bedrooms are designated as private, single occupancy, resident rooms and one (1) is designated as a double occupancy, shared resident room. Four (4) out of five (5) resident rooms have exits to the exterior. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are two (2) total restrooms. Both restrooms are designated as a shared / common resident restrooms. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 110.1-118.6 degrees Fahrenheit, all within the required range. LPA observed storage space closets in hallway containing extra clean linens and towels for resident use. KITCHEN: The LPA inspected the kitchen/food service area at 11:01 a.m. Knives and sharps were observed in a locked cabinet. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 117.1 degrees Fahrenheit at 11:02 a.m. Cleaning supplies and other chemicals are kept under the sink and in the garage. At 11:02 a.m. LPA observed the lock on the under sink cabinet to be in disrepair, malfunctioned and not lock at the time of the visit leaving chemicals accessible to residents in care. At the time of the visit the Administrator moved the chemicals to the locked garage so they are inaccessible to residents in care. LAUNDRY ROOM: LPA observed the locked laundry room adjacent to bedroom #5. Laundry room has a washer and dryer and locked cleaning supplies. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2...BACKYARD: The entire property is fenced. The backyard has a patio area with an umbrella for shade, patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed two (2) self-latching gates. There were no bodies of water noted at the time of the visit. Both pathways are used as an emergency exits which was free of obstructions at the time of the visit. GARAGE: LPA observed the attached facility garage, which was locked at the time of the visit. LPA observed emergency food and water, personal protection equipment (PPE) , incontinent supplies, and an extra refrigerator/freezer that was checked for proper labels and expiration dates. The facility’s floor plan provided to CCL did not indicate a staff room however during the physical plant tour LPA observed a locked staff room located in the garage. The Administrator stated that the room is permitted however CCL does not have any documentation or fire clearance for the staff room. The staff room is kept locked at all times and observed to be occupied by staff. LPA explained that fire clearance violations are a zero-tolerance violation and an immediate civil penalty in the amount of $500 will be assessed on today’s date (11/7/2025). LPA informed Administrator that failure to adhere to the requirements of their fire clearance may result in the assessment of additional civil penalties. RECORDS: Resident Records were reviewed beginning at 11:23 a.m. Six (6) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. Record review revealed that Resident #1 who was admitted on 09/22/2025 is missing documentation and their file is not complete including pre admission agreement, needs and service plan and signatures. Personnel Records were reviewed beginning at 1:33 p.m. five (5) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. Report Continued on LIC 809-C PAGE 4... (PAGE 4) Report Continued from LIC 809-C PAGE 3... MEDICATIONS: Medication review began at approximately 2:16 p.m. Medications are centrally stored and locked in a cabinet in the kitchen adjacent to the dining room. Medications for three (3) residents were reviewed. 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 and documented on the centrally stored medication and destruction records. No errors observed during review. LPA observed the first aid supplies to be complete, including a thermometer and a current version of a first aid manual. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster and LIC 9020A Resident roster. The Administrator emailed a copy of the Limited Liability insurance to the LPA during the visit. Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Civil penalty was issued in the amount of $500. Administrator was informed that failure to correct deficiencies may result in additional civil penalties. Exit interview conducted, report issued, and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 7, 2025

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, LPA met with facility staff. LPA explained the reason for the visit. The Administrator arrived at 02:51PM. Entrance interview conducted. Beginning at 03:06PM, the LPA along with 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: COMMON AREAS: Living room and dining room furniture was observed to be in good condition. There is a screened fireplace in the living room. The facility maintained a comfortable temperature throughout the visit. Smoke detector(s) and carbon monoxide detector were tested at 03:31PM and were operational at the time of the visit. The fire extinguishers were observed to be fully charged and last serviced 05/14/2024. All exits have auditory devices. The LPA observed required postings throughout the common space. KITCHEN: Knives and cleaning supplies are locked in an under the sink cabinet. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. GARAGE AND GROUNDS: The garage is attached to the house and locked at all times. The laundry room is located in the main hallway and is kept locked and inaccessible. Cleaning supplies and disinfectants are kept in locked cabinets in the laundry room. There is one (1) additional refrigerator in the garage with perishable items in good condition. Facility has an adequate amount of emergency food and emergency water. There is patio furniture including a table, umbrella, and chairs for resident use. Facility has one (1) fence gate that self-latches with clear passageways for emergency exit use. There were no bodies of water noted. Garage contains a staff room, which Administrator stated is permitted. Report Continued on LIC 809-C BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There are 5 (five) designated resident rooms. There was a linen closet in the laundry room with extra towels and linens. RESTROOMS: The two resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in the common hallway restroom at 146.4 degrees Fahrenheit at 03:11PM. RECORDS: Records review began at 02:35PM; four (4) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. During the resident file review, it was revealed that on 11/14/2024, Resident #1 (R1) was admitted to the facility. R1 did not contain a completed file, with only an Admission Agreement, Consent Forms, Personal Rights, and pre-Admission Appraisal. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All 3 (three) of 3 (three) staff files were complete at this time. MEDICATIONS: Medications review began at 03:40PM. The medications are centrally stored and locked in a cabinet in the kitchen. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. Administrator was advised to obtain PRN (as needed) authorization forms for all residents prescribed PRN medications. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's emergency disaster plan and infection control plan. Both documents were observed to be complete and updated annually as required. The facility conducts emergency drills every 2 months, with the last drill documented in October 2024. INTERVIEWS: During today's visit, LPA interviewed staff and residents throughout. No concerns were identified during interviews. The following deficiencies were 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 deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were issued.the state’s words, verbatim · CDSS document, Nov 19, 2024

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