Stonehedge Guest Home

Type of visit: Required - 1 Year

The LPA toured the facility including, but not limited to, residents’ rooms, bathrooms, kitchen, common areas and the backyard. The LPA observed adequate lighting for the comfort and safety of residents in all rooms. The temperature in the living room was measured at 70.8 degrees Fahrenheit. The hot water temperature was measured at 106.2 degrees Fahrenheit, within the safe range of 105 to 120 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and slip-resistant mats. There is more than the minimum of a one-week supply of nonperishable food and 2 days of perishable food. Centrally stored medications, sharps, and toxic cleaners are inaccessible to residents in care. The LPA observed required postings in the facility, including the Residential Care Facility for the Elderly Complaint Poster, Ombudsman and Personal Rights posters, and the Theft and Loss Policy. Smoke detectors and carbon monoxide detectors were tested and found to be in operating condition. Fire extinguisher was fully charged and last replaced 12/01/2025. The Emergency Disaster Plan was last reviewed on 12/01/2025. Emergency, disaster, and fire drills are conducted quarterly; the most recent drill was conducted on 10/30/2025. First aid kit was observed to be complete. Liability insurance certificate expires on 6/10/2026. The LPA reviewed 5 resident records and 5 staff records; all were complete. No citations were issued during the inspection.the state’s words, verbatim · CDSS document, Dec 1, 2025

Allegation investigated: Resident sustained a fracture due to lack of care from staff Staff did not seek medical care for resident in a timely manner

On 10/23/2025 at 12:45 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Licensee, Josefina "Penny" Gardner, to deliver the findings of above allegations. LPA explained the purpose of the visit with Licensee. During the investigation, the Department obtained and reviewed the following documents from the facility: personnel record dated 02/05/2024, residents’ roster dated 10/01/2023, admission agreement dated 09/19/2023, physicians report 09/18/2023, needs & services plans, Physicians orders dated 09/18/2023, narrative charting, medication worksheets 09/18/2023. LIC9099-C Continued... Unsubstantiated LIC9099-C (Page 2) Allegation: Resident sustained a fracture due to lack of care from staff Investigation Finding: Unsubstantiated On 12/09/2023 at approximately 0700 AM staff (S1) heard resident (R1) shouting for help, and S1 came to R1’s aid. S1 found R1 sitting on the floor, complaining of back pain while holding onto his hip. S1 did not observe any visible injuries on R1. S1 offered to call 911, but R1 declined and requested assistance to stand. S1 helped R1 back to bed and resumed his duties. Allegation: Staff did not seek medical care for resident in a timely manner Investigation Finding: Unsubstantiated Review of R1’s medical documents, from Kaiser Permanente at Walnut Creek revealed on 12/09/23 at approximately 0330 a.m., R1 sustained an unwitnessed fall. During the night shift, S1 reported the fall to the oncoming day shift caregiver, S2, at approximately 0700 a.m. At approximately 0900 a.m., S2 informed the in-house Registered Nurse (S3) of the incident. S3 provided instructions to S2 over the phone to assess R1. S2 documented no visible marks, bruises, skin tears, or discoloration, but noted that R1 moaned in pain when moved. S3 did not instruct S2 to call 911, nor did S3 advise any additional assessment. The direction provided was to administer pain medication, monitor R1 for one hour, and, if R1’s family did not respond within two hours, arrange transport to the hospital. LIC9099-C Continued... LIC9099-C (Page 3) At approximately 0725 a.m., S2 attempted to contact R1’s family. The call went to voicemail, and a message was left requesting a return call. At approximately 1100 a.m., R1’s daughter arrived at the facility. R1 was transported to Kaiser Walnut Creek Emergency Department at approximately 1200 p.m. Documentation shows that at approximately 1400 p.m., staff were notified that R1 had sustained a hip fracture. Based on records review, interviews conducted, and observations made, the Department has investigated the above allegations of “Resident sustained a fracture due to lack of care from staff” and “Staff did not seek medical care for resident in a timely manner” and found it to be unsubstantiated. A finding that the complaint allegations are unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations of resident sustained a fracture due to lack of care from staff and staff did not seek medical care for resident in a timely manner is unsubstantiated. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 23, 2025 · control 15-AS-20240202150258

Type of visit: Case Management - Other

On 10/23/2025 at 2:00 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit. LPA met with Licensee, Josefina Gardner,and explained the purpose of the visit. Josefina gave authorization for Caregiver, Sinforosa Arawiran, to sign the report. While LPA was conducting a complaint investigation #15-AS-20240202150258 on 10/23/2025, LPA observed during record review that S3 was not associated to the facility in Guardian. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights providedthe state’s words, verbatim · CDSS document, Oct 23, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87355(e)(3) · Plan of correction due date: Oct 24, 2025

e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement was not met as evidence by: Based on interview and record review the Licensee did not comply with the section cited above in having S3 associated to the facility which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Administrator submitted a copy of S3's US Issued Picture ID and LIC 9182 form to CCLD. During visit, S3 was associated to facility. Deficiency cleared.

Type of visit: Case Management - Incident

On 10/23/2025 at 3:00 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit regarding an incident report received by the Department on 12/11/2023. LPA met with Licensee, Josefina “Penny” Gardner. Licensee later had to leave and provided authorization for Caregiver, Sinforosa Arawiran, to sign the report. LPA explained the purpose of the visit. While LPA was conducting a complaint investigation (#15-AS-20240202150258) on 10/23/2025, LPA sought clarification as to why the night shift staff did not complete an assessment on Resident 1 (R1) after R1 experienced a fall during the early morning hours. Review of the facility’s incident report dated 12/09/2023 revealed that R1 fell at approximately 3:20 AM. The report indicated that Staff 2 (S2) assisted R1 from the floor and placed R1 back into bed. The report also noted that R1 had a history of hip surgery. LPA interviewed Staff 1 (S1) who stated that S2 was able to assist R1 back into bed and completed an assessment by checking for bruising, skin tears, and observing for pain or discomfort. LIC809-C Continued... LIC809-C (Page2) S1 reported that R1 did not display any signs of pain at that time, and therefore S2 did not contact 911. LPA attempted to contact S2 via text message and phone call for further clarification; however, S2 was unavailable for interview. No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report was provided to the facility representative.the state’s words, verbatim · CDSS document, Oct 23, 2025

Type of visit: Required - 1 Year

On 12/17/2024 at 1:05 PM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. At 1:45 PM, LPA met with Administrator, Josefina Gardner and explained the purpose of the visit. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. 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 114 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 10/18/2024. Emergency Disaster Plan was last posted on 01/11/2021. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 10/18/2024. LPA reviewed 6 residents records and 5 staff records; all were complete. LPA also reviewed a sample of resident’s medications. The following documents were requested and reviewed during the visit:LIC 500 Personnel Report, LIC 610E Emergency Disaster Plan, Copy of the Liability Insurance, and Current Administrator’s Certificate. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 17, 2024

Type of visit: Case Management - Health Checks

On 02/05/2024 at 10:10 AM, Licensing Program Analyst (LPA) J. Clancy-Czuleger conducted an unannounced Health & Safety inspection. LPA met with Administrator, Penny Gardner. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, medication room, and outdoor area. 7-days of non-perishables and 2-days of perishable food supplies were present. Resident's medications were kept locked in the medication cabinet. Smoke and carbon monoxide detectors are observed throughout the facility and the bedrooms. First-aid kit was complete. Fire extinguisher was observed to be full and last inspected 06/13/2023. No accessible bodies of water were observed. Indoor and outdoor passageways were free of obstruction. No deficiencies are cited on this date. Exit interview conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Feb 5, 2024

Type of visit: Required - 1 Year

On 12/29/2023 at 10:35AM, Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Debbie Rubillos and explained the purpose of the visit. Debbie phoned the Licensee, Josefina "Penny" Gardner to inform. Penny arrived at the facility approximately 11:40AM. The Administrator, Andrew Gardener, was not available. The facility’s fire clearance was approved for a resident capacity of 6 Non-Ambulatory. Hospice waiver approved for 6 residents. Administrator's Certificate #6054460740 Expires 01/05/2024. Penny gave Debbie Rubillos authorization to sign report. LPA toured facility with Penny 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 and 1 small room offside the dining room 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 108.8 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. LIC809-C Continued... LIC809-C Continued... Smoke and carbon monoxide detectors were in operating condition during visit. New fire extinguisher were purchased 06/13/2023. Emergency Disaster Plan was last posted on 10/02/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 10/02/2023. At 10:50AM, LPA reviewed 5 residents records. At 12:00PM, LPA reviewed 7 staff records and 5 of 7 have current first aid training and associated to the facility. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 1:16PM LPA observed prescription insulin located in refrigerator unlocked 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. Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 01/05/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report Liability Insurance Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 29, 2023

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.