Boyd Senior Care Home

Type of visit: Required - 1 Year

On 02/26/2026 at 10:00 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Jamil Pediguerra, and explained the purpose of the visit. Mr. Jamil Pediguerra phoned, Administrator, Jerry Pediguerra, to inform. Mr. Jerry Pediguerra arrived shortly. The facility’s fire clearance was approved for capacity six (6) residents in which all may be non-ambulatory. In addition, approval for one (1) bedridden and hospice waiver for two (2) residents. Administrator certificate #7035375740 expires 10/01/2026. LPA toured facility with Jerry including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of seven (7) total bedrooms which six (6) bedrooms are occupied by the residents and one (1) bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 120 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. LIC809-C Continued... LIC809-C (Page 2) Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 10/28/2025. Emergency Disaster Plan was last posted on 02/09/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 01/26/2026. LPA reviewed five (5) residents records. LPA reviewed five (5) staff records and 5 of 5 have current first aid training and associated to the facility. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/05/2026: LIC 308 Designation of Administrative Responsibility - Reviewed LIC 309 Administrative Organization - Reviewed LIC 500 Personnel Report - Reviewed LIC 610E Emergency Disaster Plan - Reviewed Liability Insurance - Reviewed Current Administrator’s Certificate - Reviewed No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 26, 2026

The state marks this report as 10 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff mismanaged resident's medication Staff threatened resident in care Staff did not properly maintain resident records

On 05/08/2025 at 2:30 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct initial 10-day complaint visit for the above allegations. LPA met with Caregiver, Lilia Pediguerra and explained the reason for the visit. Mrs. Pediguerra phoned Administrator, Jerry Pediguerra, to inform. Jerry arrived shortly after. LPA obtained and reviewed documents: Medication Lists and Doctor's Orders for Residents (R) R1-R5. LIC9099-C Continued... Substantiated LIC9099-C Allegation: Staff mismanaged resident's medication Finding: Substantiated On 05/07/2025 LPA interviewed Witness (W) W1, W1 stated that R1 was not being administered prescription medication according to Doctor's orders. On 05/08/2025 LPA interviewed Staff (S) S1. LPA reviewed R1-R5 medication list and observed discrepancies with R2, R3, R4 and R5's medication lists and what was centrally stored medication. S1 stated that they get information of the medications from the resident's authorized representatives. LPA reviewed R1's medication list which was a new care plan as of 05/07/2025. S1 stated that R1's new medications hadn't delivered yet. Allegation: Staff threatened resident in care Finding: Substantiated On 05/07/2025 LPA interviewed Witness (W) W1. W1 stated that caregiver(s) threatened eviction of R1 due to behaviors of overnight insomnia and restless activity. On 05/08/2025 LPA interviewed S1 that stated it has been discussed because R1's behavior with getting up in the night, wandering and disrupting the other residents. LPA reviewed R1's physician's report which indicates a diagnosis of dementia. LPA asked S1 was there a change of condition since R1 was admitted and there hasn't been any changes. LIC9099-C Continued... Allegation: Staff did not properly maintain resident records Finding: Substantiated On 05/07/2025 LPA interviewed Witness (W) W1. W1 stated that administered medications were not being documented according to medication list. On 05/08/2025 LPA interviewed Staff (S) S1. LPA requested to review the medication records for administered medication for all residents from January thru May 2025. S1 stated that they didn't have records from January and only had record for current month. LPA reviewed the Medication Administration Record (MAR) for May and observed that residents' medication lists did not correlate with the MAR. Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.the state’s words, verbatim · CDSS document, May 8, 2025 · control 15-AS-20250429090737

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(d)(3) · Plan of correction due date: Jun 5, 2025

87465 Incidental Medical and Dental Care (d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication (3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. This requirement is not met as evidenced by: Based on observation, record review and interview, the licensee did not comply with the section cited above in by ensuring R1's thru R5's MAR were complete which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, May 8, 2025

Plan of correction: Administrator agreed to complete 2hr (minimum) training for all staff with an CCLD approved vendor for Medication training with records and documenting. Submit certificates to CCLD by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jun 5, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care...that meet their individual needs and are delivered by staff...competency to meet their needs. Based on observation, record review and interview, the licensee did not comply with the section cited above in by ensuring R1 thru R5 medications were administered according to doctor's orders including but not limited to presciptions and non-prescriptions which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, May 8, 2025

Plan of correction: Administrator agreed to complete 2hr (minimum) training for all staff with an approved CCLD vendor for Medication training with prescription and non-prescription orders. Submit certificates to CCLD by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(b)(1)(A) · Plan of correction due date: Jun 5, 2025

87705 Care of Persons with Dementia (b) Licensees shall be responsible for the following:(1) Ensuring staff receive the following training... (A) Dementia care, including, but not limited to, knowledge about ...behavioral challenges.... This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above in by handling dementia care residents that may have including but not limited behavioral challenges that may be difficult for staff to handle. Staff caregiver stated possible eviction of R1 which poses a potential health, safety risk and personal rights to persons in care.the state’s words, verbatim · CDSS document, May 8, 2025

Plan of correction: Administrator agreed to complete 2hr (minimum) training for all staff with an CCLD approved vendor for Dementia Care with a focus on challenging behaviors. Submit certificates to CCLD by POC due date.

Type of visit: Case Management - Other

On 05/08/2025 at 7:30 pm Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit while conducting an investigation with complaint 15-AS-20250429090737. LPA met with Administrator, Jerry Pediguerra. During record review LPA observed that Resident (R) R4 was on insulin injections according to their medication list. LPA reviewed R4's physician's report that indicated that R4 can not administer their own injections. LPA interviewed Staff (S) S1 that stated R4 was administering their own insulin injections. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights providedthe state’s words, verbatim · CDSS document, May 8, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87628(a) · Plan of correction due date: Jun 5, 2025

87628 Diabetes (a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. This requirement is not met as evidenced by: This requirement is not met as evidenced by: Based on record review and interview conducted, R4 is diabetic and per dr's medication orders requires insulin injections daily at night. However, R4 is unable to check own blood sugar and administer own injections per current physician's report, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, May 8, 2025

Plan of correction: Administrator will submit request for exception for R4's restricted condition - diabetes management and submit to CCLD by POC date.

Type of visit: Required - 1 Year

On 03/20/2025 at 2:20 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Jerry Pediguerra and explained the purpose of the visit. The facility’s fire clearance was approved for capacity of six (6) non-ambulatory residents in which one (1) may be bedridden. Hospice waiver approved for two (2) residents. LPA toured facility with Jerry including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 6 bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 112.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 10/14/2024. Emergency Disaster Plan was last posted on 02/22/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on last year and was not current. LPA reviewed five (5) residents records. LPA reviewed five (5) staff records and 5 of 5 have current first aid training and associated to the facility. LIC809-C Completed Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/27/2025: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 20, 2025

Type of visit: Required - 1 Year

On 03/22/2024 at 10:45 AM, Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Licensee, Lilia Perdiguerra and explained the purpose of the visit. Mrs. Perdiguerra phoned the Administrator, Jerry Perdiguerra to inform. The facility’s fire clearance was approved for capacity six (6) residents. In which, five (5) may be Non-Ambulatory and one (1) may be Bedridden. Hospice waiver approved for two (2) residents. Administrator Certificate #6020992740 expires 10/01/2024. LPA toured facility with Jerry including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 140 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 10/09/2023. Emergency Disaster Plan was last posted on 03/22/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 03/15/2024. LIC809-C Continued.... LPA reviewed 3 residents records. LPA reviewed 5 staff records and 4 of 5 have current first aid training and associated to the facility. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/29/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization - If applicable LIC 500 Personnel Report - Show days/hours noted LIC 610E Emergency Disaster Plan - Reviewed Liability Insurance Current Administrator’s Certificate - Reviewed No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 22, 2024

The state marks this report as 9 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.