Amy's Residential Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Required 1 Year visit and met with Melinda Menor Lead staff, ADM was unavailable due to family emergency, ADM stated lead staff can sign on his behalf. LPA observed 6 residents and 2 staff. During visit, LPA toured the facility inside and out. LPA toured the garage area and observed food storage areas and locked cabinets for cleaning supplies. LPA observed the kitchen area and observed locked cabinets for medications, sharp objects, and cleaning supplies. LPA observed perishable food supply of at least two days and non-perishable food supply of at least seven days. LPA toured 6 resident bedrooms and 2 staff rooms . Each bedroom had available bedding and clothing storage areas as well as functioning lights. ADM tested the smoke detector and found the smoke detector to function properly when tested. LPA toured 3 resident bathrooms. Each bathroom had available soap and paper towels and functioning lights. The water temperatures in the bathroom sinks measured with thermometer at 114.4-114.6 degrees F. LPA toured the outside area and found the exits to be clear of obstructions. LPA observed fire extinguisher was last serviced on 5/21/25. LPA reviewed Fire and Earthquake log. The last disaster drill was conducted on 10/18/25 page 1 of 2 Page 2 of 2 LPA reviewed resident records for 3 residents. LPA reviewed 3 staff records. LPA and Lead Staff reviewed centrally stored medication for 3 residents. LPA observed a first aid kit that had gauze, scissors and first aid guide book. LPA observed 2 locked sheds used as storage and not living quarters. No deficiency were cited as per California Code of Regulations Title 22. This report was reviewed with Melinda Menor, Lead Staff and copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 12, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Amarjeet Mann. During visit, LPA observed 6 residents and 2 staff. LPA reviewed 3 resident files and 3 staff files. LPA toured the facility inside and out with ADM. License, Personal Rights posters, and Administrator Certificate were observed in the facility. LPA inspected living room, family room, dinning room, kitchen, and garage. There are 3 restrooms, 6 resident single rooms, and 2 staff rooms in facility. Two days perishable foods and seven non perishable foods were observed sufficient. Room temperature was observed at 72 degree F, hot water temperature was observed at 114 degree F. Medication cabinet, Knife closet, and cleaning products closet were observed locked. Fire extinguisher was serviced on 11/05/2024. The facility is equipped with fire/smoke and carbon monoxide detectors. carbon monoxide detector was tested, and was functional. First aid box, flash lights, and night nights were observed in the facility. ADM provided the 4 residents' physician report for using bed rails. Front yard and backyard were inspected. There was no obstruction to block the walkways. Two storage rooms were observed in the backyard. LPA toured the facility inside out with ADM which included; the Living room, kitchen, dining room, 3 restrooms and 7 residents bedrooms. Front yard and backyard were inspected. There was no obstruction to block the walkways. The last time the facility conducted the emergency drill was on 10/20/2024. No citation was issued today. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was provided to ADM.the state’s words, verbatim · CDSS document, Jan 7, 2025

Allegation investigated: Staff are not feeding resident.

This report is being amended from Substantiated to Unfounded. On 10/25/2024, Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the amended investigation findings and met with Administrator (ADM) Amarjeet Mann. This complaint allegation is being amended after new information has been received by the Department, On 3/14/2023, the Department received a complaint with the above allegation. On 9/18/2024, the Department delivered the investigation finding for complaint number 26-AS-20230314081243. Continue on LIC9099-C. page 1 of 2. Unfounded Staff are not feeding resident: The allegation is that resident R1 has difficulty in swallowing food and needs longer time to be fed for meals. On 3/17/2023, LPA interviewed 2 staff(S1, S2). 2 Out 2 staff stated the facility always has 2 staff during the meal time to feed residents. 2 Out 2 staff denied the facility staff did not feed resident R1. During the visit, LPA observed resident R1 was thin. LPA interviewed R1. R1 is nonverbal. R1 replied the questions by nodding or shaking his/her head for yes or no. R1 nodded his/her head when was asked if the staff fed him/her with 3 meals per day. R1 nodded his/her head when was asked if he/she felt hungry. LPA interviewed ADM. ADM denied the facility staff did not feed R1. ADM stated R1 has difficulty in swallowing food because R1 has deteriorated swallowing mechanism. ADM stated he/she will have a dedicated staff to take care of R1 to spend more time to feed R1. On 10/17/2024, LPA interviewed House Manger (HM). HM stated staff spent around 20-30 minutes to feed other residents, and spent around one and half hours to feed R1. LPA interviewed staff S1. S1 stated he/she spent at least one hour to feed R1. S1 stated he/she did not force R1 to be fed if R1 closed his/her mouth. S1 stated R1 never requested more food, and sometimes R1 refused to eat. Based on the review of R1's physician report dated 3/17/2023, R1 is unable to feed self, and R1 does not have special diet. Based on review of R1's Appraisal/Needs and Service Plan dated 3/1/2023, R1 needs 1 person assists feeding. R1 is on pureed diet with thicken liquids, and soft food as tolerated. The Department has investigated the above allegation. Based on the investigation, and interviews conducted, the Department found that the above allegation is UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. No citations noted at today’s compliant investigation visit. Exit interview was conducted with ADM. A copy of this report was provided to ADM. Page 2 of 2.the state’s words, verbatim · CDSS document, Oct 25, 2024 · control 26-AS-20230314081243

Type of visit: Case Management - Other

The purpose of this visit is to amend the complaint report for complaint number 26-AS-20230314081243 delivered on 09/18/2024. Based on a complaint investigation, when resident R1 sustained an injury to his/her left eye, the facility did not submit an incident report LIC624 to community licensing office within 7 days after the occurrence of the incident. See LIC809-D. An exit interview was conducted with Administrator (ADM) for review and signature of this report. A copy of this report was provided to ADM. Appeal rights was provided to ADM.the state’s words, verbatim · CDSS document, Oct 25, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Nov 1, 2024

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as....(1) A written report shall be submitted to the licensing agency ...within seven days of the occurrence of the events ...(D)Any incident which threatens the welfare, safety or health of any resident, This requirement was not met as evidenced by: Based on the interviews and records reviewed, the facility did not submit R1's incident report to community licensing office when R1 sustained eye injury on 2/14/2023 or 2/15/2023 which poses a potential health, and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 25, 2024

Plan of correction: Administrator stated he/she will to submit plan of correction by the POC due date to ensure the facility staff to send the incident report to community licensing office within 7 days of the occurrence of incidents..

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced case management - other visit to collect more information and met with Administrator (ADM) Amarjeet Mann. The purpose of today's visit is to clarify some questions regarding resident R1 and collect more information regrading an incident occurred before. LPA interviewed staff S1, House Manage (HM), and Administrator (ADM) Amarjeet Mann. No citation noted today. Exit interview was conducted with ADM. The report was provided to ADM for signature. A copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, Oct 17, 2024

Allegation investigated: Staff are not brushing residents teeth.

On 10/25/2024, Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the amended investigation finding report initially issued on 9/18/2024. LPA met with Administrator (ADM) Amarjeet Mann. This complaint allegation is being amended after new information has been received by the Department, On 3/14/2023, the Department received a complaint with the above allegation. On 3/17/2023, the Department conducted an initial investigation visit. LPA interviewed 3 staff and 6 residents. LPA requested resident Physician’s Report’s, Appraisal/Needs and Service Plan and schedule of staff. Continue on LIC-9099-C. Page 1 of 2. Unfounded Staff are not brushing residents teeth: On 3/17/2023, LPA interviewed Administrator (ADM) ADM stated all the 6 residents need help to brush teeth. ADM stated the staff help residents to brush teeth twice per day. ADM stated all 6 residents cannot communicate very well. LPA interviewed staff S1. S1 stated all 6 residents need help to brush teeth. S1 stated all 6 residents receives teeth brushing twice per day. LPA interviewed staff S2. S2 stated all 6 residents need help to brush teeth. S2 stated 5 out 6 residents receive twice teeth brushing per day. S2 stated 1 out of 6 resident needs to take out the denture to clean. LPA interviewed 6 residents. 3 out 6 residents were unable to answer the questions. 2 out 6 residents stated they can brush teeth by themselves. 1 out of 6 resident was unable to confirm how often he/she receives teeth brushing. LPA looked at resident R1's teeth, LPA did not see food left in the mouth or left on the teeth. LPA was unable to find out R1's teeth has oral hygiene issue. Based on the interviews and observation, there is no evidence that the staff are not brushing residents' teeth. The Department has investigated the above allegations. Based on the investigation, and interviews conducted, the Department found that the above allegation is UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. No citations noted at today’s complaint investigation visit. Exit interview was conducted with ADM. A copy of this report was provided to ADM. Page 2 of 2. Staff did not take resident to the doctor: The allegation is that the facility did not make a doctor appointment for resident R1after R1 obtained an eye injury in February 2023. On 3/17/2023, LPA interviewed ADM. ADM stated the facility helps resident R1 for doctor appointment. ADM stated R1's has eye doctor appointment on 3/28/2023. During LPA's visit, resident R1 was observed with a red eye on his/her left side. LPA interviewed R1. R1 nodded his/her head when was asked if he/she wanted to see eye doctor, but was still waiting. On 10/17/2024, LPA interviewed House Manger (HM). HM stated R1 had eye injury on 2/14/2023 or 2/15/2023 around 7-8 PM when staff was transferred R1 from wheelchair to bed and R1 obtained accidentally injury by hitting the head of the bed. HM stated R1 did not obtain bruise or open wound during the incident. HM stated R1's eye was not observed red for the first 3-4 days after the occurrence of the incident. HM stated the facility contacted R1's family doctor on 2/18/2023 for R1's red eye. HM stated the doctor prescribed OTC eye drop and ointment for R1 as needed. HM stated on 3/3/2023 R1's family doctor referred R1 to an eye doctor. HM stated the facility made an eye doctor appointment for R1 on 3/28/2023. R1's eye worsen after the occurrence of eye injury on 2/14/2023 or 2/15/2023. Based on the interviews and observation, resident R1 had eye injury and red eye, the facility staff administered doctor prescribed OTC medications to R1. The facility made eye doctor appointment for R1 more than one month after the occurrence of the eye injury. Continue on LIC9099-C. Page 2 of 3. Based on the interviews and observation, the facility did not seek timely medical attention for R1's eye injury and took more than one month to make doctor appointment. The Department has investigated the above allegations and the preponderance of evidence standard has been met. Therefore, the Department found the above allegations to be SUBSTANTIATED. Deficiencies were cited per California Code of Regulations, Title 22. See LIC9099-D. Exit interview was conducted with ADM. This report was provide to ADM for signature. A copy of the report was provided to ADM. Page 3 of 3.the state’s words, verbatim · CDSS document, Sep 18, 2024 · control 26-AS-20230314081243

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Oct 26, 2024

87465 Incidental Medical and Dental Care (a)A plan for incidental medical and dental care shall be developed ...(1) The licensee shall arrange ...for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Based on interview and record reviewed, R1 sustained an eye injury on 2/14/2023 or 2/15/2023, R1's eye worsen before the scheduled eye doctor appointment. The facility did not seek for timely medical attention for resident R1 which poses an immediate health, and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 18, 2024

Plan of correction: Administrator stated he/she will submit plan of correction by the POC due date to ensure staff to seek for timely medication attention and arrange doctor appointment for resident.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Amarjeet Mann. During visit, LPA observed 6 residents and 2 staff. LPA toured the facility inside out with ADM which included; the Living room, kitchen, dining room, 3 restrooms and 7 residents bedrooms. The staff area of the facility was also inspected. Front yard and backyard were inspected. There was no obstruction to block the walkways. Two day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 74 degrees F, and hot water temperature was measured at 118 degrees F in both resident bathrooms. Fire extinguisher was serviced in October 9, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on January 23, 2024. LPA reviewed facility records for 3 staff. LPA reviewed facility resident records for 3 residents. LPA requested resident weight records for R1-R3. ADM stated she only measures the residents weight when they go to their annual doctors visit. LPA reviewed 3 resident medications and centrally stored medication records. While reviewing R2's medication records, LPA discovered discrepancy in medication bottle #1. R2's medication states give two tablets by mouth nightly, with a start date of 12/16/23, and a pill count of 100. LPA reviewed R2's MAR, and there was no refusals. LPA audited the medication and observed only 5 tablets available. ADM does not know why there is an odd number of tablets. Page 1 out of 2. LPA also reviewed Resident R3's medications. R3's medication bottle #1 states take 1 tablet daily, with a pill count of 90. The centrally stored medication log states the medication was being administered starting 12/22/2024. A review of R3's MAR, shows the medication was not refused, and has been administered. An audit of R3's medication showed a total of 53 pills. LPA asked ADM why there was a discrepancy, if the medication began on 12/22/23 ( 10 days of medication administration in the month of December and 31 days for the month of January, 31+10=41) If 41 tablets have been administered, then the medication bottle needs to have 49 pills, because the facility MAR shows zero refusals. ADM stated she is unsure why there is an excess of 4 medication pills. LPA conducted interviews with 2 staff (S1 & S2) and 2 residents (R1 & R2). Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. Exit interview was conducted with Administrator Amarjeet Mann and a copy of the signed report & appeal rights were provided. Page 2 out of 2.the state’s words, verbatim · CDSS document, Jan 31, 2024