Addie Meedom House

Allegation investigated: Staff confiscated resident's call bell/pendant. Staff did not allow resident visitors.

At approximately 10:55AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into the above allegations. LPA met with Interim Administrator Lucy Russell, interviewed staff and reviewed records. During this investigation, LPA reviewed resident call pendant logs and observed resident, R1, utilized the call button several times a day with no apparent gaps in time that would lead a person to believe the button had been removed. Staff interviewed stated they would never take a call button away from a resident since that is how staff are alerted to their need of assistance. LPA reviewed records regarding visitation for resident, R2. LPA observed R2 has a conservator that has utilized their authority to restrict visitors without the conservators permission. The facility has a procedure to follow when someone wished to visit with R2, where permission could be granted by the conservator. Facility followed regulation and conservator wishes by refusing visits for R2 without conservators permission. LPA did not observe any other restrictions on visitors for other residents and observed several visitors during this investigation. This agency has investigated the above allegations. We have found that the complaint was unfounded, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Unfoundedthe state’s words, verbatim · CDSS document, Jul 29, 2026 · control 21-AS-20260519121854

Type of visit: Case Management - Legal/Non-compliance

At approximately 10:55AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Legal/Non-Compliance visit and to follow up on an incident report submitted by the facility. LPA met with Interim Administrator Lucy Russell, toured the building and reviewed records. The following areas of non-compliance were addressed today: · Personal Rights · Staffing · Fingerprint Clearance · Reporting Requirements LPA reviewed staff training and observed all staff have recently received training in residents personal rights and another is scheduled for next month. Administrator informed LPA they will ensure new employees receive all required training in the first 4 weeks of employment and will have refresher personal rights training throughout the year. LPA verified that all staff employed at the facility have a background clearance and are associated to the facility. LPA verified there are no staff or other individuals other than residents, living in the building. LPA reviewed records and observed the facility has been submitting unusual incident reports as required. On 04/18/2026, staff entered residents, R1, room and found them eating barrier cream. R1 had the cream on their chest and tongue. Staff assisted with cleaning up and ensured the cream was removed. LPA reviewed residents file and observed there were no previous issues with hygiene products and no indication on the physicians assessment that resident was at risk. Facility updated the care plan and changed procedures to ensure hygiene products are not accessible. All notifications were made within timelines. No citations issued during today's visit.the state’s words, verbatim · CDSS document, Jul 29, 2026

Type of visit: Case Management - Legal/Non-compliance

At approximately 1:15PM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Non-Compliance Conference. Licensing Program Manager Kimberly Mota and Regional Manager Carla Nuti-Martinez were present during this visit via Microsoft Teams. LPA met with Executive Director Machellee Allison, Chief Operating Officer Amy Smith, Chief Financial Officer Scott Sampson and Business Office Manager Lucy Russell. On September 5, 2025, the Department received a complaint alleging Neglect/Lack of supervision resulted in resident being sexually assaulted, Staff did not prevent a resident from engaging in inappropriate sexual behavior in a common area. Based on the complaint investigation the Department substantiated the allegations. The following areas of non-compliance were addressed today: · Personal Rights · Staffing · Fingerprint Clearance · Reporting Requirements Facility will be put on a two (2) year Non-Compliance Plan and has agreed to be a part of the Technical Support Program. A copy of the Appeal for the April 14th visit was provided during this visit. Continued on LIC809-C... Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Machellee Allison and Appeal rights were given.the state’s words, verbatim · CDSS document, May 28, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(h)(5) · Plan of correction due date: May 29, 2026

87405 Administrator - Qualifications and Duties:(h) Administrator shall have the responsibility to: (5) Provide or ensure the provision of services to...residents with appropriate regard for... physical & mental well-being and needs... Requirement wasn't met as evidenced by: based on interviews, records reviewed, & observations, Administrator didn't ensure R1 records reflected correct care needs & did not ensure R2 safety measures were in place. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, May 28, 2026

Plan of correction: Licensee to have Administrator review Regulation 87405 - Administrator Qualifications and Duties and submit a written policy defining Administrator Role and Responsibilities. Plan to be submitted by POC due date of 5/29/26.

Allegation investigated: Neglect/Lack of supervision resulted in resident being sexually assaulted Staff did not prevent a resident from engaging in inappropriate sexual behavior in a common area

At approximately 9:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to deliver findings from an investigation conducted by the Department into the above allegations. LPA met with Executive Director Machellee Allison. Neglect/Lack of supervision resulted in resident being sexually assaulted: Based on interviews conducted and a review of records indicate that resident, R1, was transferred from Memory Care to Assisted Living within a week of admission, resulting in a reduced level of supervision. R1’s care plan required that R1’s location be known at all times, due to exit seeking behaviors. Interviews conducted with staff, indicate that R1 should not have been moved out of Memory Care if such behaviors were present and staff were unable to explain the rationale for the downgrade in R1’s care. On 9/1/2025, staff observed R1 in Resident's (R2) room and reported the abnormal behavior to management; no immediate risk indicators were identified at that time. Statements confirm that on 9/3/2025, after staff observed R2’s door being closed, which is not common for R2 which is left open for staff to check on R2 every 30 minutes or so for safety checks. On 9/3/25, staff entered R2’s room and witnessed R1 sexually assaulting R2. Staff promptly intervened, contacted emergency medical services and law enforcement. Continued on LIC9099-C... Substantiated Interviews revealed that over two hours had passed without staff awareness of R1s’ whereabouts prior to the incident. Based on the above information there is sufficient evidence to conclude that staff failed to provide the level of supervision required to prevent the incident. Based on records reviewed and interviews conducted, the facility failed to provide safety and adequate supervision to R2 that resulted in R2 being sexually assaulted. Staff did not prevent a resident from engaging in inappropriate sexual behavior in a common area: Based on interviews conducted and a review of records confirm that Resident, R3, did not require one-to-one supervision and was permitted to access communal areas. R3’s physician’s report documented a history of sexual behaviors and R3 exhibited sexually inappropriate behaviors upon admission to the facility. Staff redirected R3’s sexually inappropriate behavior in accordance with his care plan, regularly notified external providers, and initiated the process that led to their transfer to a specialized Memory Care Facility on 11/4/2025. However, interviews indicate that R3’s sexually inappropriate behaviors occurred significantly more frequently than documented and created a safety risk to other residents. R3 was reported to have been aggressive towards staff and did not respond to redirection. Facility did not increase R3’s level of supervision or modify their care plan to mitigate this risk. There is sufficient evidence to substantiate that staff failed to provide adequate supervision to prevent R3 from engaging in inappropriate sexual behaviors in communal areas. Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. An immediate civil penalty is being assessed today in the amount of $500 for a violation that resulted in the sickness or injury of a resident in care. The licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code 1569.49(f), or 1548(e) or (f), 1568.0822(f) Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Machellee Allison and Appeal rights were given.the state’s words, verbatim · CDSS document, Apr 14, 2026 · control 21-AS-20250905092410

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87461(a)(5) · Plan of correction due date: Apr 15, 2026

87461 Mental Condition:(a) The facility shall determine the amount of supervision necessary by assessing the mental status of the prospective resident to determine if the individual:(5)has a documented history of behaviors which may result in harm to self or others. This requirement is not met as evidenced by: Based on records reviewed, Licensee did not ensure the necessary supervision was given, resulting in resident being sexually assaulted. This poses an Immediate Health, Safety or Personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 14, 2026

Plan of correction: Licensee agrees to submit a written plan describing how the facility will ensure residents needs are met and the proper supervision is provided. Plan should address the re-appraisal process for changes in condition including inappropriate interactions with residents and staff. Written plan shall be submitted to CCL by 04/15/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Apr 15, 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 resident needs. This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, Licensee did not ensure staff were suffiencent in number to meet residents needs and to prevent sexually inappropriate behaviors. This poses an Immediate Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 14, 2026

Plan of correction: Licensee agrees to submit a written plan describing how the facility will ensure residents needs are met and the proper supervision is provided. Plan should address the re-appraisal process for changes in condition including inappropriate interactions with residents and staff. Written plan shall be submitted to CCL by 04/15/2026.

Type of visit: Case Management - Other

At approximately 9:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, and met with Executive Director Machellee Allison. The purpose of this visit was to deliver the findings from an investigation conducted by the Department. During the course of the investigation it was discovered that in September 2025, an incident occurred between two residents, where resident, R3, went into resident's, R4, room and performed a sexually offensive act while holding their hand. R4 called out for assistance from staff and R3 was escorted out of the room. The facility did not report the incident to CCLD. An additional issue was discovered during the course of the investigation. Between March and September 2025, the Executive Director was living at the facility. During this time frame, the Director's spouse was observed to come and visit the Director for up to a week at a time. The Spouse was observed walking the hallways in the evening. LPA reviewed the fingerprint roster that identifies individuals who have a criminal background clearance for the facility and observed their name did not appear on the list. An immediate civil penalty is being issued in the amount of $100 per day for five (5) days, totalling $500. A mandatory office meeting will be scheduled to discuss compliance concerns at the facility. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Machellee Allison and Appeal rights were given.the state’s words, verbatim · CDSS document, Apr 14, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.17(b)(1)(B) · Plan of correction due date: Apr 15, 2026

87355 Criminal Record Clearance: (B) Any person, other than a client, residing in the facility. This requirement is not met as evidenced by: Based on interviews conducted, the Executive Directors spouse was reported to have stayed at the facility for up to a week at a time between March and September 2025. This poses an immediate Health, Safety or Personal Rights risk to persons in care. An immediate civil penalty is being issued in the amount of $500.the state’s words, verbatim · CDSS document, Apr 14, 2026

Plan of correction: Licensee agrees that all staff and persons living in the facility who are not residents receive a criminal records clearance. Director no longer lives at the facility. Cleared during visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(D) · Plan of correction due date: Apr 30, 2026

87211 Reporting Requirements: (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by: Based on interviews conducted An incident occurred between two residents that was not reported to CCLD. This poses a potential Health, Safety or Personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 14, 2026

Plan of correction: Licensee agrees to review regulation 87211 with all staff. Licensee shall submit Self Certification they have read and will comply with regulation going forward. Self Certification shall be submitted to CCL by 04/30/2026.

Type of visit: Case Management - Other

At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into some supplemental allegations that arose during the course of a complaint investigation. LPA met with Administrator Designee Lucy Russell and interviewed staff. During the course of the Departments investigation, allegations were made that the Executive Director was witnessed to be intoxicated while in the facility, walking around barefoot and smelling of alcohol and to have what appeared to be beer bottles in their care between 05/2025 through 09/2025. LPA conducted interviews and was informed the allegations were true, however, the Director was not on duty at the time. During this time period, the Director was living in one of the rooms of the facility and these instances occurred either after hours or on days when the Director was not working. LPA verified the Director does not provide care services for residents and does not handle medications. LPA was not provided information to support the allegation that the Director was under the influence of alcohol during work hours. No citations issued during today's visit.the state’s words, verbatim · CDSS document, Mar 27, 2026

Type of visit: Required - 1 Year

At approximately 9:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Machellee Allison and explained the purpose of the visit. Administrator certificate is current. Facility has a Hospice waiver for 10 residents. At approximately 9:30AM, LPA toured the facility to ensure the health and safety of residents in care. The facility was observed to be at a comfortable temperature. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and outdoor areas. In the areas toured no immediate health, safety, or personal rights violations were observed. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. Fire sprinklers were present. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The kitchen equipment was clean and in good repair. Dishware appeared to be stored in a sanitary manner. Food appears to be stored and prepared properly. Refrigerators and freezers were maintained at the proper temperature. Facility has required supply of perishable and non-perishable food. Emergency water was present to ensure facility can be self-sufficient for 72 hours. Facility has a generator to supply power in an emergency. Emergency lighting devices were present. First aid kit was present. No pools/bodies of water are on the premises. Facility has been conducting Emergency drills every 3 months. At approximately 10:15AM, LPA reviewed 7 of 24 resident files. All resident files contained the required documentation. Reappraisals were conducted within the last 12 months. Documentation of a physician visit within the last 12 months was present. Medication records were organized and contained orders for each medication. Medications were secured in a locked cabinet. Continued on LIC809-C… At approximately 12:30PM, LPA reviewed 7 staff files. Staff files reviewed contained evidence of completed annual training. First Aid/CPR certification was current. All employees requiring background checks are cleared. During this inspection, LPA followed up on an incident report that was submitted to CCLD on 01/30/2026. The incident was in regards to a respite resident who eloped from the facility. LPA reviewed records and interviewed staff regarding the incident and was informed the resident was within line of sight during the whole event. Resident broke their window screen and climbed through the window and was met by staff and returned to the building. The facility modified windows to prevent them from opening enough to allow an individual from exiting. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report Evidence of Liability Insurance No deficiencies were observed in the areas inspected, No citations were issued during today’s visit.the state’s words, verbatim · CDSS document, Mar 17, 2026

Type of visit: Case Management - Incident

At approximately 2:30PM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct a case management visit in regards to a special incident report submitted to the Department on 02/18/2025. LPA met with Executive Director Angela Stevens and reviewed records. The incident was in regards to a staff member accidentally pouring urine, from a juice bottle, into a cup for a resident during a medication pass. This facility does not utilize a medication cart during medication pass. The Medication technician bring medication to each residents room. The medication technician entered the residents room to assist with medications and observed several bottles of juice on the counter top. The resident had recently received the juice from a family member. The medication technician poured what appeared to be apple juice from one of the open bottles and gave it to the resident. Resident took the medication and drank the liquid. Resident told staff that the liquid was their urine. Based on records reviewed, resident lives in the assisted living section of the building and does not have a dementia diagnosis. There were no prior incidents where resident used a bottle to urinate in. Staff immediately removed the bottles from the residents room. Resident responsible person was notified. Facility placed resident on alert charting and updated their care plan. No citations issued during todays visit.the state’s words, verbatim · CDSS document, Mar 3, 2025

Type of visit: Required - 1 Year

At approximately 8:05AM, Licensing Program Analyst (LPA) Chris Arnhold made an unannounced annual required inspection of this licensed senior care facility. LPA met with Administrator Angela Stevens in the parking lot. She informed LPA she would not be able to stay as she had an appointment. LPA met with Business office manager Lucy Jones for the inspection. At approximately 8:30AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in a locked storage closet. Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire extinguishers inspected were charged. Smoke detectors were found to be in working order. Facility has fire sprinklers throughout. Carbon Monoxide detectors were present. There was enough lighting in all common areas, resident rooms, and hallways. Facility has a backup generator to supply power in an emergency. Medication is centrally stored and secure. Activity supplies were plentiful and a schedule of activities was posted. At approximately 9:00AM, LPA reviewed 8 resident records. Eight of eight records contained current and signed admission agreements, current physician reports and resident care plans. Medication records are thorough and contained physician's orders for each resident. At approximately 9:45AM, LPA reviewed 8 staff records. 8 of 8 records contained documentation of completed annual training as required. Evidence of current first aid and CPR training was current. At approximately 10:30AM, LPA reviewed the facility emergency disaster plan. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducts and documents disaster drills Quarterly. LPA received evidence of Liability insurance during this visit. No citations issued during today's visit.the state’s words, verbatim · CDSS document, Feb 11, 2025

Allegation investigated: Neglect/Absence of supervision

At approximately 8:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into the above allegation. LPA met with Administrator Angela Stevens, toured the building and reviewed records. Based on interviews conducted and records reviewed, Resident, (R1), had a history of non-payment and leaving the facility for several days. On 01/21/2024, staff entered R1's room and found the window screen was cut out and residents room key and pendant were on the bed. Staff searched the area and notified Law Enforcement of a missing person. R1 returned a few days later. This occurred a few more times. On 2/05/2024, R1 was observed by staff leaving the facility through the front doors. LPA reviewed residents record and found they were able to make their own decisions and paid for their own care. Continued on LIC9099-C... Unfounded R1 is able to leave the facility unassisted. Facility followed regulation and contacted Law Enforcement each time R1 did not return to the facility. Facility was in the process of requesting an updated physician report for R1 at the time of their departure. R1 was no longer a resident of this facility as of 02/05/2024. This agency has investigated the above allegation. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.the state’s words, verbatim · CDSS document, Apr 16, 2024 · control 21-AS-20240408125815

Allegation investigated: Lack of supervision resulting in resident’s fall.

At approximately 10:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into the above allegation. LPA met with Administrator Angela Stevens, toured the building and reviewed records. Based on interviews conducted and records reviewed, resident was found on the floor of their room after falling. Interview with staff revealed they were assisting another resident when the fall occurred. The resident was discovered shortly after the fall and staff assisted them. LPA reviewed staffing records for the time in question and found facility had sufficient staff at the time. Based on records reviewed, resident did not sustain injury and was found shortly after the incident. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 4, 2024 · control 21-AS-20240201111036

Allegation investigated: Staff does not ensure resident's needs are being met due to inadequate staffing. Staff did not provide responsible party with changes of fee increases of resident's care plan.

At approximately 10:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into the above allegations. LPA met with Administrator Angela Stevens, toured the building and reviewed records. Based on records reviewed and interviews conducted, facility did not have a sufficient number of staff to meet the needs of residents. LPA addressed this concern on 02/08/2024 during the annual inspection. Since that date, facility has adjusted staffing levels to ensure they have staff sufficient to meet resident needs. Based on records reviewed and interviews conducted, facility sent notices to all residents and responsible parties on November 1, 2023 regarding an increase in care costs. The notice only informed them of their new rate, that would begin January 1, 2024. Residents and responsible parties were not advised of any other future additional costs. Continued on LIC9099-C Substantiated LPA reviewed records regarding resident care. LPA observed staff complete a full body/skin check every few days to ensure changes in condition are captured. Based on interviews conducted, staff will assist residents with hand washing before meals, but sometimes residents will soil their hands again without staff notice. LPA reviewed facility documentation regarding staff observations. Facility uses progress notes for each resident to document and track healing injuries or changes of condition, Body/skin check forms to document changes of condition, Communication logs to pass information between staff and incident reports that are created for Licensing. Facility staff are trained to document things when they are observed. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Administrator and Appeal rights were given.the state’s words, verbatim · CDSS document, Apr 4, 2024 · control 21-AS-20240129105252

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655(a) · Plan of correction due date: May 3, 2024

(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice...the reason for the increase, and a general description of the additional costs. This requirement is not met as evidenced by:Licensee did not notify residents of a Hospice fee. This poses a potential personal rights risk to residents.the state’s words, verbatim · CDSS document, Apr 4, 2024

Plan of correction: Licensee to send an updated notice to all residents and responsible parties of the new rate structure, including but not limited to, all potential fees or charges they may be subject to while residing at the facility. Notice to be sent to all families and CCL by POC date of 05/03/2024.

Type of visit: Case Management - Annual Continuation

At approximately 8:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived unannounced to continue the annual required inspection. LPA met with Administrator Angela Stevens. At approximately 8:45AM, LPA reviewed 6 resident records. Six of six records contained current and signed admission agreements, current physician reports and resident care plans. Medication records are thorough and contained physician's orders for each resident. LPA will follow up with Licensee regarding recent changes to the Admission agreement and the increase in the cost of care that were not submitted to the Department. At approximately 10:45AM, LPA reviewed 6 staff records. 5 of 6 records did not contain documentation of completed annual training as required. Evidence of current first aid and CPR training were current. LPA and Administrator discussed staffing requirements throughout the building. Based on a review of resident records and staff schedules, LPA observed the facility does not have a sufficient number of staff to meet residents needs. At approximately 12:30PM, LPA reviewed the facility emergency disaster plan. Facility has a generator to supply power during an outage. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducted and documented a disaster drill in January 2024. Continued on LIC 809-C... While conducting this inspection, LPA followed up on an unusual incident report submitted by the facility on 12/26/2023. A staff member observed a resident waiting for their meal and gave the resident a plate containing turkey. The resident was allergic to turkey which was noted in the physician report and care plan. Facility contacted the physician and kept resident under observation. No ill effects were observed. Facility has implemented a new system in the kitchen for all staff to be aware of diet restrictions for each resident. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC309- Administrative Organization LIC500- Personnel Report LIC610E- Disaster Plan Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Angela Stevens and Appeal rights were given.the state’s words, verbatim · CDSS document, Feb 8, 2024

Type of visit: Required - 1 Year

At approximately 1:15PM, Licensing Program Analyst (LPA) Chris Arnhold made an unannounced annual required inspection of this licensed senior care facility. LPA met with Angela Stevens. At approximately 1:45PM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in a locked storage closet. Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire extinguishers inspected were charged. Smoke detectors were found to be in working order. Facility has fire sprinklers throughout. Carbon Monoxide detectors were present. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure. LPA will return at a later date to review staff and resident records.the state’s words, verbatim · CDSS document, Feb 7, 2024