7121 Main

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Talwinder Bains arrived on 09/15/25 to conduct the annual inspection. LPA met with staff, Sevrena Miller (S1) and explained the purpose of today's visit. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed two (2) residents files and two (2) staff files and found them to be complete. LPA and S1 toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, and common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. LPA checked the kitchen area for the ability to prepare and store food. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire Extinguisher was last serviced on 03/07/25 and was ready for emergency use. Inside temperature was 74 degree F during visit. Hot water was measured at 105 degree F which was in required range from 105-120 degree F. Several topics were discussed. LPA requested a copy of the LIC308, LIC 500, LIC610E and current liability insurance to be sent to the Department by 09/30/25. No deficiencies were observed and cited per Title 22 Regulations from this visit. Exit interview conducted. Copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 15, 2025

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

On 12/04/24, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced to conduct a case management visit. LPA met with Staff, Sevrena Miller explain the purpose of the visit. The purpose of the visit is to gather more information regarding a death report (LIC624A) Community Care Licensing (CCL) received on 12/02/24. LPA spoke with facility staff regarding the events leading up to resident, R1s death. Death report states that R1 passed away in the hospital on 11/30/24 after being sent out due change of condition on 11/27/24. LPA requested a copy of R1's LIC602 and ID page. This case is under review and Department will follow up as warranted. At this time, no deficiencies are cited. Exit interview conducted and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Dec 4, 2024

Allegation investigated: Staff sexually assaulted resident. Staff did not treat resident with dignity and respect. Staff spoke to resident in an inappropriate manner. Staff handled resident in a rough manner. Staff did not assist resident with care needs in a timely manner.

On 11/07/24, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced and met with Staff, Sevrena Miller to deliver complaint findings into allegations listed above. LPA explained the purpose of the visit upon arrival. The department conducted records review ,facility observations and interviews to investigate the complaint. **Report continued on LIC9099-C** Unfounded **report continued from 9099..... Allegation- Staff sexually assaulted resident. Unfounded- The Department conducted six (6) residents and three (3) staff interviews to investigate this allegation. Resident, R1 disclosed in their interviews with Department that they were NOT sexually abused by staff at the facility. R1 stated that staff were not gentle with them while providing care to them but that was not sexual abuse in any manner. Three (3) Staff interviews and six (6) resident’s interviews indicated that they had no information about any sexual abuse to any residents. Based on this information, this allegation was found to be UNFOUNDED. Allegation - Staff did not treat resident with dignity and respect. Staff spoke to resident in an inappropriate manner. Staff handled resident in a rough manner.- UNFOUNDED -The Department conducted six (6) residents and three (3) staff interviews to investigate these allegations. The Department interviewed three (3) staff and six (6) residents during complaint investigation visit on 10/23/24. Interviews did not indicate any residents, staff and/or witness observed that staff are not providing privacy to residents in care. Department observed during facility tour on 10/23/24 that facility staff were attentive to resident’s needs and providing them privacy while taking care of them and during resident’s personal time with families and visitors. During residents’ interviews, residents stated that facility staff are meeting their care needs and did not express any concerns with privacy or dignity. Residents’ interviews indicated that staff were treating all residents with dignity and respect and did not express any issues. Five out of six resident’s interviews indicated their satisfaction with staff’s professionalism and did not express any issue with staff were being rough with their care or speaking to them in any inappropriate manner. Based on facility tour, interviews and observation, the department found this allegation is to be UNFOUNDED. Allegation- Staff did not assist resident with care needs in a timely manner. -UNFOUNDED- The department conducted three (3) staff and six (6) residents' interviews, reviewed records to investigate the allegation. During residents’ interview, residents stated that staff respond in a timely manner, however sometimes there is a delay in response due to staff assisting other resident’s needs. Interviews and record review indicated that resident’s ADL’s which includes residents showering, incontinence and care needs are met as required and documented accordingly. Five (5) out of six (6) Residents’ interviews indicated that staff were providing care in a professional manner and their care needs were met and did not express any concerns. Three (3) staff interviews indicated that there were no issues with staffing and staff were assisting with all residents needs in timely way without any problems. Based on this information, this allegation is found to be UNFOUNDED. Based on the investigation, the preponderance of evidence standards has not been met. Therefore, the above all allegations is found to be UNFOUNDED. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. Exit meeting conducted. A copy of this report has been provided to facility. **report continued from 9099-A...... Allegation- Staff did not adequately assist resident with showering, resulting in a fall. -UNSUBSTANTIATED The department conducted record review and interviewed staff and residents to investigate this allegation. Resident, R1 indicated that they had a fall on 09/20/24 when they were getting shower and staff were assisting them. R1 stated that they been sent to hospital after that fall incident and they hurt their back . Staff interviews indicated that R1 had a fall in the shower room on 09/20/24 when staff were helping R1 with shower and R1 fell as R1 attempted to stand up with sidebar but could not hold their body weight and slid on floor with staff’s assistance. After the fall incident, staff called the Emergency services and was transferred to local hospital to get medical treatment. Record review indicated that facility reported this fall incident to Department as required. From gathered information, it has been concluded that although, R1 had a fall incident in the shower room on 09/20/24, it was not due to lack of care and supervision of the facility and facility took appropriate measures to address R1s health issues after the fall incident. Based on this information, this allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted. Copy of the report provided.the state’s words, verbatim · CDSS document, Nov 7, 2024 · control 59-AS-20241010122227

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Talwinder Bains arrived on 09/17/24 to conduct the annual inspection. LPA met with staff, Sevrena Miller (S1) and explained the purpose of today's visit. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed medications of two (2) residents comparing with physician orders. LPA reviewed two (2) residents files and two (2) staff files. LPA and S1 toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, and common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. There is a side gate for emergency access. LPA checked the kitchen area for the ability to prepare and store food. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire Extinguisher was last serviced on 03/15/24 and was ready for emergency use. Inside temperature was 76 degree F during visit. Hot water was measured at 106 degree F which was in required range from 105-120 degree F. Several topics were discussed. LPA requested a copy of the LIC308, LIC 500, LIC610E and current liability insurance to be sent to the Department by 09/30/24. No deficiencies were observed and cited per Title 22 Regulations . Exit interview conducted. Copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 17, 2024

The state marks this report as 4 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.