Alta Vista Manor

Allegation investigated: Licensee is not adhering to resident's admission agreement. Staff mismanaged resident's medication.

On 05/13/2026, Licensing Program Analyst (LPA) Jacqueline Shaw-Ross arrived unannounced at the facility to deliver findings of the investigation regarding the allegations listed above. The LPA met with Administrator, Anna Wilson, and informed her of the purpose of her visit. The investigation included staff interviews, a review of records, and collection of relevant documentation. It was alleged that the family of R1 believed they would not receive a partial refund following R1's passing on 12/26/2025. The family had paid in advance for the period of 12/5/2025, through 01/05/2026, and believed they were entitled to a refund for the remaining nine days. A review of R1's Admission Agreement was conducted and indicated that "Any refund of fees paid in advance for the time following the resident's death would be issued within 15 days after all of the resident's personal belonging had been removed from the facility." Continued LIC 9099-C.... Unsubstantiated A review documents and interviews conducted with staff revealed that the family of R1 was issued a check for the appropriate refund amount, which covered the remaining nine days following R1's passing. The family of R1 became upset when the administrator attempted to assess an additional charge for painting the bedroom walls. However, no additional fees were ultimately charged for normal wear and tear. Therefore the allegation that the Licensee is not adhering to the resident's Admission Agreement is unsubstantiated. It was alleged that staff mismanaged R1's medication by failing to administer morphine to the resident. Interviews conducted with staff and a review of obtained documents revealed that R1 had a physician's order for morphine to be administered on an as-needed basis for pain and shortness of breath. Additionally, an interview with R1's family indicated there were no concerns regarding the administration of medication to the resident. Therefore the allegation that staff mismanaged R1's medication is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violations occurred. An exit interview was conducted and a copy of this report, and appeal rights were provided to Anna Wilson.the state’s words, verbatim · CDSS document, May 13, 2026 · control 18-AS-20260105132727

Allegation investigated: Staff administered unprescribed medication to residents. Staff did not meet requirements to administer medications.

On 05/13/2026, Licensing Program Analyst (LPA) Jacqueline Shaw-Ross, arrived unannounced to the facility to conduct an investigation into the above allegations. LPA met with Anna Wilson, Administrator and the purpose of the visit was explained. A tour of the facility was conducted inside and out. There were no health or safety issues observed. The Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Staff Interviews (S#1-S#2), Resident Interview (R#1-R#2), review of medication log, review of how medications are dispensed. LPA obtained the following documents: Resident Roster, Staff roster, Facility Staff Annual In-service training sheet dated: 04/19/2026. It was alleged that staff administer unprescribed medication to residents. Of the interviews conducted, 2 out of 2 residents report they have never been given unprescribed medication or witnessed any other resident being given medication that was unprescribed. Continued on LIC 9099-C... Unsubstantiated Of the staff interviews conducted, 3 out of 3 staff report they have never instructed or been instructed to give unprescribed medication to residents in care. Medications are bubble packed and stored in a locked room and in a locked cabinet, and MAR system is actively utilized and maintained. Therefore the allegation that staff are giving out unprescribed medication to residents in unsubstantiated. It was alleged that caregivers did not meet the requirements to administer medication to residents. Of all of the residents interviews, 2 out of 2 residents report they have never observed the facility having untrained staff administer medication. Of all of the staff interviews conducted, 3 out of 3 staff report they have never had or observed untrained caregivers administer medication. Based on all information gathered including interviews with staff and residents, review of medication training records, MARS, and observation of medication administration procedures, there was no indication that staff failed to meet the requirements for administering medications. Investigation revealed that only designated staff are permitted to administer medications. Medications are maintained in bubble packs, and designated staff prepare the medications in cups before hand them to caregivers, who then provide the medications to residents. Review of records confirmed the most recent medication training was conducted on 04/19/2026. Therefore, the allegation that staff do not meet the requirements to administer medications to residents in care is unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 13, 2026 · control 18-AS-20260507220746

Type of visit: Required - 1 Year

On 4/28/26, Licensing Program Analyst (LPA) Kyle Wellington arrived unannouncedt to conduct an annual inspection. LPA met with the Administrator (Admin), Anna Wilson, who was informed of the purpose of the visit. Admin informed LPA there are 13 residents and 7 staff members at the facility. The facility has a fire clearance to serve fifteen (15) non-ambulatory elderly residents of which one (1) may be bedridden in bedroom 11. LPA received a resident and staff roster from the Admin. LPA did a tour of the inside and outside of the facility with the Admin. LPA conducted observations and record reviews for the inspection. The facility is a one story building containing 14 resident bedrooms and 14 resident bathrooms, kitchen, dining room, laundry room, TV room, and common area. There are multiple outdoor shaded areas with seating for residents. Indoor and outdoor passageways along with entrances and exits were free of obstructions. There is no swimming pool on the property. LPA observed a fire alarm system, carbon monoxide detectors, and charged fire extinguishers throughout the facility. A receipt for the fire extinguishers showed they were purchased on 5/6/25. The facility's fire protection system passed its fire safety inspection by the Vista Fire Department on 7/10/25. LPA observed cleaning supplies were stored in the locked laundry room inaccessible to residents for regular facility cleaning and maintenance. LPA observed the kitchen could prepare and store food in a safe and clean manner. The facility has a two day supply of perishable foods and a seven day supply of non perishable foods. LPA observed residents medications were secured in a locked cabinet in the locked laundry room inaccessible to residents. LPA observed staff and resident files were stored in a locked cabinet inaccessible to unauthorized people. LPA reviewed two (2) staff and three (3) resident files. The files contained all the required documentation and paperwork. No deficiencies were cited during this visit. Exit interview was conducted with the Administrator and a copy of this report was given to the Administrator.the state’s words, verbatim · CDSS document, Apr 28, 2026

Type of visit: Case Management - Health Checks

On April 15, 2026, Licensing Program Analysts (LPA), Jacqueline Shaw-Ross arrived unannounced to conduct a Case Management Health and Safety visit, and met with facility Manager, Andres Nevaarez and explained the purpose of the visit. During the visit LPA conducted a tour of the facility and made observations. There were no Health and/or Safety issues observed at this time. LPA conducted a review of the records to include the Emergency Approval to Operate (EAO). LPA observed facility utilities to be operating at the time of this visit. LPA assessed the available food supply and observed there was a variety of food types. Additionally, the supply exceeds the required two-day supply of perishable food items, and a seven-day supply of non-perishable foods. The medications were found to be locked, and inaccessible to the residents in care, with an automated delivery rotation by Quality Care Pharmacy, (QCP). Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and welfare of the residents in care. No deficiencies were observed or cited during today's visit. An exit interview was conducted, and a copy of this report was provided to Facility Manager, Andres Nevaarez.the state’s words, verbatim · CDSS document, Apr 15, 2026

Type of visit: Case Management - Health Checks

On 03/06/2026, Licensing Program Analyst (LPA), Jacqueline Shaw-Ross arrived unannounced to conduct a Case Management Health and Safety visit, and met with Administrator, John Wilson. During the visit LPA toured the facility along with the Administrator, John Wilson, and made observations. There were no Health and/or Safety issues observed at this time. LPA observed facility utilities to be operating at the time of this visit. LPA assessed the available food supply and observed there was a variety of food types. Additionally, the supply exceeds the required two-day supply of perishable food items, and a seven-day supply of non-perishable foods. The medications were found to be locked, and inaccessible to the residents in care, with an automated delivery rotation by Quality Care Pharmacy, (QCP). Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and/or welfare of the residents in care. No deficiencies were observed or cited during today's visit. An exit interview was conducted, and a copy of this report was provided to the Administrator, John Wilson.the state’s words, verbatim · CDSS document, Mar 6, 2026

Type of visit: Case Management - Health Checks

On December 09, 2025, Licensing Program Analysts (LPA), Venus Mixson arrived unannounced to conduct a Case Management Health and Safety visit, and met with the Administrator, Anna Wilson. During the visit LPA toured the facility along with the Administrator, Anna Wilson, and made observations. There were no Health and/or Safety issues observed at this time. LPA observed facility utilities to be operating at the time of this visit. LPA assessed the available food supply and observed there was a variety of food types. Additionally, the supply exceeds the required two-day supply of perishable food items, and a seven-day supply of non-perishable foods. The medications were found to be locked, and inaccessible to the residents in care, with an automated delivery rotation by Quality Care Pharmacy, (QCP). Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and/or welfare of the residents in care. No deficiencies were observed or cited during today's visit. An exit interview was conducted, and a copy of this report was provided to the Administrator, Anna Wilson.the state’s words, verbatim · CDSS document, Dec 9, 2025

Type of visit: Case Management - Health Checks

On October 31, 2025, Licensing Program Analysts (LPA), Venus Mixson arrived unannounced to conduct a Case Management Health and Safety visit, and met with Administrator, Anna Wilson. During the visit LPA toured the facility along with the Administrator, Anna Wilson, and made observations. There were no Health and/or Safety issues observed at this time. LPA conducted a review of the records to include the Emergency Approval to Operate (EAO), with a new date of renewal for 09/19/ 2025, effective until 11/19/2025/, with a license number of 371881533. The Licensee informed LPA Fire Department has approved the fire clearance for the new license. LPA observed facility utilities to be operating at the time of this visit. LPA assessed the available food supply and observed there was a variety of food types. Additionally, the supply exceeds the required two-day supply of perishable food items, and a seven-day supply of non-perishable foods. The medications were found to be locked, and inaccessible to the residents in care, with an automated delivery rotation by Quality Care Pharmacy, (QCP). Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and/or welfare of the residents in care. No deficiencies were observed or cited during today's visit. An exit interview was conducted, and a copy of this report was provided to the Administrator, Anna Wilson.the state’s words, verbatim · CDSS document, Oct 31, 2025

Type of visit: Case Management - Health Checks

On August 26, 2025, Licensing Program Analysts (LPA), Venus Mixson arrived unannounced to conduct a Case Management Health and Safety visit, and met with Administrator, Anna Wilson. During the visit LPA toured the facility along with the Administrator, Anna Wilson, and made observations. There were no Health and/or Safety issues observed at this time. LPA conducted a review of the records to include the Emergency Approval to Operate (EAO), with a new date of renewal for 07/25/ 2025, effective until 09/13/2025/, with a license number of 371881533. Administrator informed LPA Fire Department has approved the fire clearance for the new license. LPA observed facility utilities to be operating at the time of this visit. LPA assessed the available food supply and observed there was a variety of food types. Additionally, the supply exceeds the required two-day supply of perishable food items, and a seven-day supply of non-perishable foods. The medications were found to be locked, and inaccessible to the residents in care, with an automated delivery rotation by Quality Care Pharmacy, (QCP). Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and welfare of the residents in care. No deficiencies were observed or cited during today's visit. An exit interview was conducted, and a copy of this report was provided to the Administrator, Anna Wilson.the state’s words, verbatim · CDSS document, Aug 26, 2025

Type of visit: Required - 1 Year

On 4/1/425 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a 1yr required inspection. LPA met with Administrators Anna Wilson and John Wilson where LPA explained the purpose of the visit. During today's visit LPA verified facility contact information, the facility is currently in the process of undergoing a change of ownership. The facility is licensed to have 1 bedridden resident whom resides in bedroom #11. The facility currently has (3) residents receiving hospice services. LPA conducted a tour of the interior and exterior areas of the facility. The facility was observed to be clean and clutter free. Each resident has their own bathroom, and bedroom. LPA observed for there a rectangle shape cut out form the ceiling by the kitchen sink due to the facility getting upgraded fire sprinklers. The facility was advised by the Fire Marshall to not put the dry wall up until the final fire system inspection is completed. LPA inquired about the annual fees that are due by 4/24/25, and the payment will be mailed today per Administrator Anna. The smoke and carbon monoxide detectors were observed to be operable. There are no pools or bodies of water on the premises. The facility is conducting drills at minimum of a quarterly basis with the last drill was completed on 4/5/25. All staff present were observed to have criminal record clearance, and to be associated to the facility. All staff CPR certification was observed to have expired in March 2025, the upcoming class is scheduled for 4/24/25. Deficiency cited. The food supply was sufficient. The medications, sharps and chemicals were observed to be locked and inaccessible to residents in care. The resident file had medical assessments, and admissions agreements. Based on today's inspection a citation will be issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted and a copy of this report, 809D, appeal rights, LIC9098-Proof of Corrections form was reviewed and provided to Anna Wilson, Administrator.the state’s words, verbatim · CDSS document, Apr 14, 2025

Allegation investigated: Staff refused to provide medical records to resident’s authorized representative. Staff took possession of resident's personal property.

Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to deliver the findings of the investigation into the above allegations. The LPA met with Administrator, Anna Wilson, and informed her of the purpose of her visit. The investigation included staff and resident interviews, a review of records, and collection of relevant documentation. A report was received alleging a representative of Resident One (R1) made several requests to receive medical records for the resident; however, the request was not fulfilled by the facility. Administrator Wilson was interviewed and denied the allegation. She reported there was no request received for copies of R1's records. She also reported the facility was not in possession of any of R1's medical records. A copy of email correspondence, dated 01/09/2022, was obtained which revealed a discussion between the facility Licensee, John Wilson, and an individual identified as a family member of R1. The correspondence was regarding the Unsubstantiated pending delivery of R1's records to the family member by the Licensee. The correspondence, however, did not provide confirmation of the request being satisfied. Licensee Wilson was not available to be interviewed. Administrator Wilson reported having no knowledge of the request for records and had no knowledge of whether the request was satisfied by the Licensee or not. R1 was not available to be interviewed, as the resident passed away on 01/02/2022, prior to the receipt of the allegation. R1's resident file was not available for review prior to the completion of the investigation. Staff and resident interviews could provide no information regarding the allegation. Therefore, due to a lack of information that could either refute or corroborate the allegation, this complaint is deemed UNSUBSTANTIATED at this time. Another allegation was received alleging Administrator Wilson and Licensee Wilson stole R1's personal belongings from the resident's house after their death on 01/02/2022 and were attempting to take possession of R1's home title. Administrator Wilson was interviewed and denied having any of R1's personal property. Administrator Wilson did report she and Licensee, John Wilson, did ask the resident to sell their home to them for a price of $900,000.00 after the resident voluntarily discharged from the facility, sometime in 2018. According to Administrator Wilson, R1 refused to sell their home to either herself or Licensee Wilson. Licensee Wilson was not available to be interviewed. R1 was not available to be interviewed due to their passing on 01/02/2022, prior to the receipt of the allegation. R1's resident file was not available for review; however, Administrator Wilson was able to provide the LPA with an Admission Agreement showing R1 was admitted to the facility on 06/24/2017. Staff and resident interviews could provide no information regarding the allegation. Interviews were attempted with the authorized representatives of R1. One of two parties to respond reported having knowledge of alleged reports made by Administrator Wilson that R1 offered to sell their property to the staff members. The representative reported R1's property had not been sold to either the Administrator or the Licensee, though both parties were in pursuit of taking control of the resident's property via lawsuit. No documentation or other information was available to reveal when R1 left the facility or what the resident's medical diagnoses were at the time of admission. Therefore, due to a lack of information that could either refute or corroborate the allegation, this complaint is deemed UNSUBSTANTIATED at this time. A finding the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violations occurred. This report was reviewed with Administrator Wilson and a copy was provided.the state’s words, verbatim · CDSS document, Jan 28, 2025 · control 18-AS-20220608160358

Type of visit: Case Management - Other

On December 31, 2024, Licensing Program Analysts (LPA), Venus Mixson arrived unannounced to conduct a Case Management Health and Safety visit, and met with Administrator, Anna Wilson. During the visit LPA toured the facility along with the Administrator, Anna Wilson, and made observations. There were no Health and/or Safety issues observed at this time. LPA conducted a review of the records to include the Emergency Approval to Operate (EAO), with a new date of renewal up until the 13, of January 2025. The administrator has followed up scheduled with the local fire department, but called during today’s visit, to determine there are no current issues or concerns with the present system. The Licensee just wanted to upgrade the system and was not aware this would be such a lengthy process. LPA observed facility utilities to be operating at the time of this visit. LPA assessed the available food supply and observed there was a variety of food types. Additionally, the supply exceeds the required two-day supply of perishable food items, and a seven-day supply of non-perishable foods. The medications were found to be in sufficient supply, locked, and inaccessible to the residents in care, with an automated delivery rotation by Quality Care Pharmacy, (QCP). Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and welfare of the residents in care. No deficiencies were observed or cited during today's visit. An exit interview was conducted, and a copy of this report was provided to the Administrator, Anna Wilson.the state’s words, verbatim · CDSS document, Dec 31, 2024

Type of visit: Case Management - Health Checks

On November 14, 2024, Licensing Program Analysts (LPAs), Armando Perez and Abdoluaye Zerbo arrived unannounced to conduct a case management health and safety visit. LPAs met with administrator, Anna Wilson. LPAs conducted record reviews to include the Emergency Approval to Operate (EAO), (LIC 9117), LIC 9020 Roster of Facility Clients/Residents, and Personnel Roster (LIC 500). LPAs observed the EAO with the expiration date of November 13, 2024. An additional request is pending. Administrator informed LPAs that the Fire clearance inspection is pending repair work on the sprinkler system. The administrator stated that five companies are bidding for the repair and two companies, by the name of Fire ETC and Spencers Fire are providing estimates today. LPAs did not observe any health and/or safety hazards inside or outside of the facility at the time of this visit. LPAs observed all facility utilities to be on and operating without issue. LPAs assessed the available food supply and observed there was a variety of food types, and the supply exceeds the requirement of a two-day supply of perishable foods and a seven-day supply of non-perishable foods. The medications were found to be in sufficient supply, locked, and inaccessible to the residents and are delivered by Quality Care Pharmacy. Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and welfare of the residents in care. No deficiencies were observed or cited during today's visit. An exit interview was conducted, and a copy of this report was provided to the Administrator, Anna Wilson.the state’s words, verbatim · CDSS document, Nov 14, 2024

Type of visit: Case Management - Health Checks

On October 01, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced to conduct a case management health and safety visit, and met with the Administrator, Anna Wilson. LPA Mixson made introductions explained the purpose of the visit. LPA Mixson toured the facility, along with the Administrator and made observations and requested and received pertinent documents. There are no imminent health and/or safety concerns observed at the time of visit. Spoke with the Vista Fire Department, Fire inspector and investigator stated all is going according to plan and we are waiting on the approval. LPA Mixson did not observe any health and/or safety hazards inside or outside of the facility at the time of this visit. LPA observed all facility utilities to be on and operating without issue. LPA assessed the available food supply and observed there was a variety of food types, and the supply exceeds the requirement of a two-day supply of perishable foods and a seven-day supply of non-perishable foods. The medications were found to be in sufficient supply, locked, and inaccessible to the residents and are delivered by Quality Care Pharmacy. Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and welfare of the residents in care. No deficiencies were observed or cited during today's visit. An exit interview was conducted, and a copy of this report was provided to the Administrator, Anna Wilson.the state’s words, verbatim · CDSS document, Oct 1, 2024

Type of visit: Case Management - Health Checks

On September 13, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced to conduct a Case Management Health and safety visit, and met with the Administrator, Anna Wilson. LPA introduced herself and explained the purpose of the visit. LPA toured the facility, along with the Administrator and made observations and requested and received pertinent documents. There are no imminent health and/or safety concerns observed at the time of visit. Administrator informed LPA that all requirements for the Change of Ownership has been completed and the new application for the Emergency Approval to Operate (EAO), will be completed by close of business today. LPA discussed the documents required and the need to submit documents as soon as possible as the EAO has expired. Administrator provided copies of previous EAO's and email from CAB Analyst. Administrator informed LPA that the Fire Suppression System is being updated and waiting for approval from fire department. LPA Mixson did not observe any health and/or safety hazards inside or outside of the facility at the time of this visit; LPA observed perimeter with a locked secured black iron gate with a sounding alarm when opened. LPA observed all facility utilities to be on and operating without issue. LPA observed bedrooms to have the required furnishings per regulations. LPA Mixson assessed the available food supply and observed there was a variety of food types, and the supply exceeds the requirement of a two-day supply of perishable foods and a seven-day supply of non-perishable foods. The medications were found to be in sufficient supply, locked, and inaccessible to the residents and are delivered by Quality Care Pharmacy. Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and welfare of the residents in care. An exit interview was conducted, and a copy of this report was discussed and given to the Administrator, Anna Wilson.the state’s words, verbatim · CDSS document, Sep 13, 2024

Type of visit: Case Management - Health Checks

On July 12, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced to conduct a case management health and safety visit. LPA met with administrator, Anna Wilson. LPA Mixson toured the facility, along with the Administrator, and made observations. LPA reviewed records and inspected the facility inside and out and requested and received pertinent documentation. LPA conducted record reviews to include the Emergency Approval to Operate, (LIC 9117), LIC 9020 Roster of Facility Clients/Residents, and Personal Roster (LIC 500). Administrator informed LPA that the Fire clearance inspection is scheduled for 07/17/2024. LPA observed the facility utilities to be operating without issue and assessed the available food. There was a variety of food types available for the residents in care and the food supply meets the requirement of a two-day supply of perishable foods and a seven-day supply of non-perishable foods. The medications were found to be in sufficient supply, locked, and inaccessible to the residents in care. Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and/or welfare of the residents in care. No deficiencies were observed or cited during today's visit. An exit interview was conducted, and a copy of this report was provided to Administrator, Anna Wilson.the state’s words, verbatim · CDSS document, Jul 12, 2024

Type of visit: Required - 1 Year

On April 04, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Required Annual Inspection and met with the Administrator, Anna Wilson. The facility file review was conducted in the Regional Office and additional forms were reviewed and requested on site. The facility is licensed for 15 Elderly Adults but currently is serving nine seniors. LPA Mixson toured the facility along with the Administrator and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is a located at 625 Marazon Lane, Vista, Ca. 92081. Physical Plant: The facility phone number is (760) 522-2008 and it is operable. The LPA observed the residents’ bedrooms, and each was equipped with required furniture as per Title 22. LPA Mixson inspected facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean, and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. The LPA observed required postings such as "If you See Something, Say Something" the "Personal Rights" and the Ombudsman postings. The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the residents and staff files, and it was locked and inaccessible to residents in care currently at the time of this visit. Medications: Were locked and inaccessible to residents in care, and there was a sufficient supply of medication for each resident. The overall facility is clean, the furniture is in good condition. The facility heating system and other appliances were operable currently at the time of this visit, and there were safety lights for night. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly, and sharps are locked. Care & Supervision: Facility has sufficient staff, four staff on site at the time of this visit, and engaging the residents with activities and medication management. Records Review: The LPA reviewed resident and staff files, conducted staff interviews, and observed several residents participating in activities, and residents occupied with family visits. Previous Community Care Licensing forms were reviewed. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit. An exit interview was conducted, and a copy of this report was given to the Administrator, Anna Wilson.the state’s words, verbatim · CDSS document, Apr 4, 2024

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA), Yolanda Delgado arrived unannounced to conduct a case management health and safety visit, and met with the Administrator, Anna Wilson. LPA Delgado introduced herself and explained the purpose of the visit. LPA Delgado toured the facility, along with the Administrator and made observations and requested and received pertinent documents. There are no imminent health and/or safety concerns observed at the time of visit. LPA Delgado did not observed any health and/or safety hazards inside or outside of the facility at the time of this visit; LPA observed perimeter with a locked secured black iron gate with a sounding alarm when opened. LPA observed all facility utilities to be on and operating without issue. LPA observed bedroom #11 that is designated as a bedridden room according to fire clearance with a non-bedridden resident; LPA observed bedroom #6 non-bedridden room with a bedridden resident. The LPA assessed the available food supply and observed there was a variety of food types, and the supply exceeds the requirement of a two day supply of perishable foods and a seven day supply of non-perishable foods. The medications were found to be in sufficient supply, locked, and inaccessible to the residents and are delivered by Quality Care Pharmacy. Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and welfare of the residents in care. One (1) deficiencies were observed and cited during today's visit. An exit interview was conducted and a copy of this report, LIC 809D and Appeal Rights was provided to the Administrator, Anna Wilson.the state’s words, verbatim · CDSS document, Mar 12, 2024

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87202(a)(2) · Plan of correction due date: Mar 14, 2024

FIRE CLEARANCE: All facilities shall maintain a fire clearance approved...County fire department, or district providing fire protection services, or the State Fire Marshal...(2) Bedridden persons This requirement is not being met as evidenced by: LPA Delgado observed (1) bedridden resident in a non-bedriddgen room according to the approved fire clearance. This poses a potential health and safety risk to the clients in care.the state’s words, verbatim · CDSS document, Mar 12, 2024

Plan of correction: Administrator will submit a plan regarding the room change. Administrator will ensure the current approved fire clearance is followed. Administrator will submit the plan by the POC due date.

Allegation investigated: Facility staff not meeting residents incontinence needs Facility staff are not changing a residents bedding Facility staff failed to keep the facility free of odors

Licensing Program Analyst Becky Kennedy concluded the investigation which began on 4/22/2021. LPA Kennedy made an unannounced visit to the above facility today and met with Administrator, Anna Wilson. LPA advised them of the reason for today's visit and delivered the investigation findings on the above allegations. It was alleged that Resident 1’s (R1) room smelled of urine, the bed sheets had feces, and that R1’s brief had not been changed and appeared very saturated. The investigation into the above allegations consisted of interviews with staff, outside sources, a review of records, and virtual tour of the interior and exterior of the facility. Unsubstantiated The investigation revealed that the facility had thirteen residents in care, nine of whom were incontinent and required full care with their toileting needs. The facility has three care staff on duty during waking hours and two during the night. Interviews revealed that care staff check on each resident every two hours including overnight, and provide care as needed. The facility training material regarding incontinence care is thorough and includes cleanliness of laundry and furniture as well as getting rid of lingering odors. Per mayoclinic.org “skin that is constantly in contact with urine may get irritated or sore and can break down. This happens with severe incontinence if you don't take precautions, such as using moisture barriers or incontinence pads.” The investigation revealed that R1 did not have any skin breakdown. An outside source was in the facility four days after the above concerns were alleged and no concerns were identified by the outside source during that visit. Interviews and documentation did not provide enough evidence to prove a violation occurred therefore these allegations are found to be unsubstantiated. An exit interview was conducted and a copy of this report, and appeal rights were given to Anna Wilson.the state’s words, verbatim · CDSS document, Jan 10, 2024 · control 08-AS-20210416145607

Type of visit: Case Management - Health Checks

On December 29, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced to conduct a case management health and safety visit, and met with the Administrator, Anna Wilson. LPA Mixson introduced herself and explained the purpose of the visit. LPA Mixson toured the facility, along with the Administrator and made observations and requested and received pertinent documents. There are no imminent health and/or safety concerns observed at the time of visit. LPA Mixson did not observed any health and/or safety hazards inside or outside of the facility at the time of this visit. LPA observed all facility utilities to be on and operating without issue. The LPA assessed the available food supply and observed there was a variety of food types, and the supply exceeds the requirement of a two day supply of perishable foods and a seven day supply of non-perishable foods. The medications were found to be in sufficient supply, locked, and inaccessible to the residents and are delivered by Quality Care Pharmacy. Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and welfare of the residents in care. No deficiencies were observed or cited during today's visit. An exit interview was conducted and a copy of this report was provided to the Administrator, Anna Wilson.the state’s words, verbatim · CDSS document, Dec 29, 2023

Type of visit: Office

On November 20, 2023, the Department held an informal meeting to discuss the death of the Licensee for the facility. In attendance was Regional Manager (RM) Reyna Lacey, Licensing Program Manager (LPM), Jazmond Harris via Teams, Licensing Program Analyst (LPA), Yolanda Delgado and Licensee's facility administrator Anna Wilson and John Wilson. The following was discussed, Anna Wilson notified the Department of the death and expressed she will continue the operations of the facility. During the meeting she provided a copy of the notarized designation to continue to operate, declaration that she has no criminal convictions. The designee agreed to provide a copy of the licensee’s death certificate, obituary notice, certification of death from the decedent’s mortuary, or a letter from the attending physician or coroner’s office verifying the death of the licensee, within 20 working days of the licensee’s death. The application will be turned in by December 1, 2023. Anna will also submit a hospice waiver request by COB 11/22/2023. Anna Wilson was advised to submit the application to: Adult and Senior Care Program Centralized Application Bureau 744 P Street, MS 9-14-8201, Sacramento, CA 95814 When application is received, an Emergency approval to operate (EAO) will be issued.the state’s words, verbatim · CDSS document, Nov 20, 2023