Anna Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado and Lorena Kho arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry by Wilnekka Bradford LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Infection Control plan on file. Resident record review began- Four (4) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. LPA began review of employee records- Two (2) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and expires 09/09/2027. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 120.0 degrees F. (Continued on next page) (Continued from Page 1) Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. Food Service- Food supply meets the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation, and the structure remains unchanged according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 12/8/2025. The facility is conducting emergency disaster drills. The last disaster drill was conducted on 07/2025, documentation requested and unable to be provided. No firearms are stored on premises and no bodies of water observed. Corporation or LLC is not active and is not in good standing. Based on the information received during this visit today, there are three (3) deficiencies that are being cited per Title 22, Division 6 of The California Code of Regulations. This report, LIC809D and Appeal Rights was reviewed with Ms. Bradford and a copy provided at the time of the exit interview. LPA was away from the facility from 12:20-1:20PMthe state’s words, verbatim · CDSS document, Dec 8, 2025

Allegation investigated: Resident was sexually abused by an unknown perpetrator

Licensing Program Analyst (LPA) Yolanda Delgado made an unannounced visit to the facility to investigate the allegation listed above. LPA met with Caregiver, Wilnekka Bradford and explained the purpose of the visit. LPA called Administrator Annalissa Blancaflor via the telephone and left a voicemail. During the investigation, LPA conducted interviews and reviewed documents pertaining to the allegation. It was alleged Resident #1 (R1) was sexually abused by an unknown perpetrator and was seen at the hospital on February 18, 2025, “Resident was sent to the ER by the order of the facility's in house doctor. Doctor was concerned that resident may have been pregnant because a pregnancy test result for resident was "inderterminate. Interviews with facility staff revealed R1 is not a current resident and is unknown to the staff, facility does not have a facility doctor by name and is unknown to the staff, none of the current residents have been sent to the ER on February 18, 2025. The LPA reviewed resident roster. R1’s name was not listed on the current resident roster. (Continued on Page 2) Unfounded (Continued from Page 1) LPA conducted a Health & Safety check of residents in care and there are currently six (6) residents and two (2) caregivers on duty, three (3) residents are in the living area watching TV and three (3) residents in their room awake in bed watching TV or eating. This agency has investigated the complaint alleging "Resident was sexually abused by an unknown perpetrator ". 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. There were no deficiencies and no civil penalties that were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided to Wilnekka Bradford.the state’s words, verbatim · CDSS document, Feb 21, 2025 · control 18-AS-20250220161404

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Infection Control plan on file. House Manager arrived after LPA's arrival. Resident record review began- Four (4) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 111.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals; cleaning supplies observed on the ground. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. Food Service- Food supply meets the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. LPA began review of employee records- Two (2) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening-1 misssing and TB (Continued on next page) (Continued on from Page 1) test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is not present and is not current. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation and the structure remains unchanged according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 11/2024. The facility is conducting emergency disaster drills. The last disaster drill was conducted on 02/2024, documentation requested and unable to be provided. No firearms are stored on premises and no bodies of water observed. LPA allocated time to prepare this report for delivery. Based on the information received during this visit today, there are five (5) deficiencies that are being cited per Title 22, Division 6 of The California Code of Regulations. This report was reviewed with and a copy provided to the facility representative. Appeal Rights were also provided at the time of the exit interview.the state’s words, verbatim · CDSS document, Nov 14, 2024

Allegation investigated: Staff did not administer resident's medications as prescribed

On 01/22/2024, Community Care Licensing received a complaint alleging Staff did not administer resident’s medication as prescribed. It was reported that the facility staff did not administrator the R1’s medications as prescribed. In regards to the allegation that the Staff did not administer resident's medications as prescribed. It was reported that the facility did not give medications to the R1 and R1’s medication was found sitting on the desk. During the LPA’s records review and observations, the facility does not keep a record such as a Medications log of when the medications where distributed to the residents. LPA interviewed the Administrator and staff members, who stated they know when to give medications to their residents and base this off of reading the doctor’s order and when breakfast, lunch and dinner are given. Unsubstantiated The residents will get their medications as a routine before or after they eat their meals. LPA was unable to interview R1 due to R1’s passing. The other residents interviewed indicted no issues with receiving their medications on time. LPA reviewed the Centrally Stored Medication Logs for the residents. This allegation is unsubstantiated. Additional interviews could not provide any information to corroborate or refute the allegation. Therefore, due to insufficient information, this allegation is deemed unsubstantiated at this time. Based on the LPA’s observation, interviews conducted and record review, the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report, was discussed with and provided to the Caregiver, April Ann Reyes.the state’s words, verbatim · CDSS document, Jul 29, 2024 · control 18-AS-20240122145635

Allegation investigated: Staff interfered with resident's right to receive hospice care or other services

Licensing Program Analyst (LPA) Kathleen Banrasavong conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegation. LPA met with Caregiver, April Ann Reyes where LPA explained the purpose of the visit and the elements of the allegations. The investigation consisted of observation, interviews with staff members and residents, and records review. On 01/22/2024, Community Care Licensing received a complaint alleging staff interfered with resident's right to receive hospice care or other services. It was reported that the facility staff interfered with the resident’s right to receive hospice care or other services. It was alleged that Administrator, Annalisa Blancaflor refused to let a staff member from the Hospice agency into the facility due to a precautionary rule to protect the residents and staff from Covid-19 exposure. Information obtained from interview with Administrator stated that she told Hospice Social Worker, volunteers, and aids that they could not come into the facility, but can meet with the Resident #1 (R1) out in the front porch. Substantiated It was advised that no residents or staff had Covid 19, but she wanted to implement this policy because the holidays were a time for Covid 19 cases. Blancaflor stated that she only allowed Registered nurse (RN) and the Licensed Vocational Nurse (LVN) to come into the facility. LPA interviewed staff members from the hospice company who stated that due to the condition of the R1, it was not in the best interest of R1 to meet with anyone outside of the facility. It was advised that the restriction started on November 30, 2023 and lasted until February 6, 2024. Documents were reviewed regarding hospice staff sign in dates to corroborate the visits attempted and successfully made. LPA was unable to interview R1 due to R1 passing away on March 20, 2024. Based on LPA’s observations, interviews conducted, and record review(s), the allegation that staff interfered with resident’s rights to receive hospice care and other services, the preponderance of evidence standard has been met; therefore, the allegation is SUBSTANTIATED. This poses a health and safety and or personal rights risk to clients in care. The facility will be cited per Title 22 Regulations Division 6, 87468.1(a)(11), are being cited on the attached LIC 9099D. An exit interview was conducted, and a copy of this report, the 9099-D, and appeal rights was discussed with and provided to the Caregiver, April Ann Reyes .the state’s words, verbatim · CDSS document, Jul 29, 2024 · control 18-AS-20240122145635

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87468.1(a)(11) · Plan of correction due date: Aug 9, 2024

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (11)To have their visitors...advocacy representatives, permitted to visit privately during reasonable hours and without prior notice,...This requirement was not being met as evidenced by: The LPA conducted interviews with the Administrator and pertinent parties. It was confirmed that the Administrator restricted visitors for R1. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 29, 2024

Plan of correction: Licensee shall read the regulation and provide a sign written affidavit of understanding the regulation section. Proof of correction is due to the Department 08/09/2024.

Allegation investigated: Staff did not ensure that medication was inaccessible to residents in care

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to initiate and deliver findings regarding the allegation listed above. LPA was granted entry and met with caregiver Coleena Rom, who was informed of the purpose of the visit. Regarding the allegation “Staff did not ensure that medication was inaccessible to residents in care”, during the tour of the facility, LPA observed two medication cabinets located in the kitchen open and accessible to residents in care. LPA inquired about the medication cabinets being unlocked and staff stated the cabinets were not locked due to a prior visit from LPA Cheryl Goodrich who had conducted an unannounced visit at the facility earlier today. It was documented that LPA Goodrich left the facility at 11:05am. LPA’s interview with staff revealed they are aware the medication cabinets need to be locked and inaccessible to residents in care at all times. Substantiated Resident One (R1) Hospice Agency record review reveals on 01/25/2024, a hospice RN documented they found an unused fentanyl patch on the kitchen counter that was accessible to residents in care. Hospice RN documented they destroyed the fentanyl patch. Therefore, based on interviews, observation, and record reviews, the allegation “Staff did not ensure that medication was inaccessible to residents in care” has been deemed SUBSTANTIATED at this time. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. The facility will be cited pursuant to Title 22, regulation 87464(h)(2). An exit interview was conducted where a copy of this report was reviewed and provided along with LIC9099-D and Appeal Rights.the state’s words, verbatim · CDSS document, Jan 30, 2024 · control 18-AS-20240126082057

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(h)(2) · Plan of correction due date: Jan 31, 2024

87465 Incidental Medical and Dental Care: (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons...This requirement was not met as evidenced by: Based on interviews, observations, and record review, Licensee did not ensure medications were inaccessible to residents in care as LPA observed the medication cabinets open and accessible to the residents which poses an immediate health and safety risk.the state’s words, verbatim · CDSS document, Jan 30, 2024

Plan of correction: Licensee agrees to provide training to all staff on the importance of keeping all medications locked at all times when not in use. Licensee will submit proof of staff training to LPA by the POC date 01/31/2024.

Type of visit: Required - 1 Year

On 12/04/23 Licensing Program Analyst (LPA) Javina George arrived unannounced to the facility noted above to conduct an annual inspection. LPA was greeted and granted entry by Caregiver Bituin Mendoza. LPA met with the Administrator Annalisa Blancaflor, who arrived after LPAs arrival. Below is an account of LPAs observations of the conducted inspection: Physical plant: The facility was observed to be within the licensed capacity (6). At the time of LPAs visit all residents were asleep taking their afternoon naps. LPA was able to successfully conduct one (1) resident interview. LPA was unable to check the mattresses. LPA observed for the resident bedrooms to have night stands, storage space, and sufficient lighting. The facility temperatures were comfortable for residents in care. LPA measured the hot water temperature in two (2) resident bathrooms, initially the water temperature was too hot, the water heater was adjusted and the water temperature ranges were retested and observed to be within regulatory limits of ranging from 115-117 degrees Fahrenheit. The carbon monoxide and smoke detectors were tested and were observed to be operable. The facility was stocked with a 2-day supply of perishable and 7-day supply of non-perishable food items that were labeled appropriately. Personnel: The facility administrator certificate expired and the renewal packet was sent off the month after it was due (10/2023). The administrator will send proof of completion to the department by 5pm on 12/5/23. In addition the Administrator's CPR/First Aid expired on 06/19/2020. Deficiency cited. There is a locked and centralized storage area for medications, which is located in the kitchen above the microwave. The facility had a designated area for resident files and staff files, however there were no other staff files available for review but the Administrator's. Per the Administrator the facility is in the process of updating the staff files which is why they were not at the facility. The administrator is to submit proof of staff #1 (S1) employee file to the department by 5:00pm on 12/5/23. All staff present have a criminal record clearance on file and are associated to the facility. The facility was not observed to have all the required postings however did have such as Ombudsman poster and PUB475. See citations below. The facility was also equipped with one (1) fire extinguisher and one (1) complete first aid kit as well as the first aid manual. LPA inspected the outdoor area of the facility. The facility has a covered patio. The facility is in compliance as the business' governing body is active and functioning. The licensing renewal fees are due by 12/18/23, and was discussed with the Administrator. The following citation(s) are being issued as the facility has not been conducting emergency disaster drills on a quarterly basis nor documenting the conducted drills. In addition the facility did not have personnel files available for review at the time of LPAs visit. The administrator's CPR/First Aid expired 06/19/2020. Further the facility does not have a completed Emergency Disaster Plan (LIC 610E). The citation(s) can be found on the attached 809D. An exit interview was conducted and a copy of the report, 809D, and appeal rights were reviewed and provided to Annalisa Blancaflor, administrator.the state’s words, verbatim · CDSS document, Dec 4, 2023