Anne's Place IV

Type of visit: Required - 1 Year

On 07/31/26, Licensing Program Analyst (LPA) Aziz Faizi made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by caregiver Monica Martinez who was informed of the purpose of the visit. The facility is a one-story home with seven (7) bedrooms and three (3) bathrooms, including a garage. There are no pools or known firearms on the premises. LPA toured the facility's exterior and observed outdoor pathways were free of obstructions. Outdoor shaded seating area is available for the clients in care. The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. LPA toured the kitchen and observed the facility has a two-day supply of perishable foods and more than a seven-day supply of non-perishable foods, which are stored in a safe and healthy manner. LPA observed knives and sharp instruments secured in locked kitchen cabinets. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 105.9°F. Fire extinguishers equipped throughout the building are maintained in accordance with the department's safety requirements expiring on 08/26/2026. Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate expiring on 12/07/2027. Continued with 809C LPA reviewed files for five (5) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Five (5) resident files were reviewed and contained all required documentation. All resident medications were securely locked in cabinets. LPA observed medications were checked and listed ensuring accuracy and proper documentation by the facility and staff. LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire/earthquake drill conducted on 07/02/2026, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, Jul 31, 2026

Allegation investigated: Staff is financially abusing a resident while in care.

On May 7, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced follow-up investigation regarding a complaint. During the visit, the LPA met with the Administrator, Dearme Doverte, and explained the purpose of the visit. The investigation involved collecting records and touring the facility. On this date, the Department obtained various documents, including the Personnel Report (LIC 500) dated March 18, 2026, and the Resident Roster also dated March 18, 2026. The Department reviewed and collected documentation for resident #1, which included the Face Sheet dated February 24, 2022; Admission Agreement dated February 24, 2022; Physician's Report dated February 14, 2024; Appraisal Needs and Services Plan dated June 6, 2024; Medical Notice of Action dated December 1, 2023; Medical Action Approval dated July 1, 2024; Assisted Living Waiver dated August 2, 2024; and the Death Report dated November 15, 2024. The Department interviewed the Licensee, the Administrator, three staff members (S1-S3), and three other residents (R2-R4). The LPA was unable to interview resident #1 (R1), as R1 had passed away on November 11, 2024. Unsubstantiated Allegation #1: Staff financially abusing a resident while in care. The complaint alleged that the licensee sought to become the resident's representative for financial matters to oversee the Medi-Cal process. On May 7, 2026, the department interviewed the licensee, who denied the allegation, stating that the resident's responsible party (RP) had asked the facility to transport the resident (R1) to a Medi-Cal appointment because the RP lived outside San Diego. During the same interview, the department interviewed the Administrator (A1), who also denied the allegation. A1 explained that R1's Medi-Cal was set to expire soon and needed to be renewed; if it expired, the Assisted Living Waiver (ALW) would remove R1 from the program. A1 stated that, since the RP, who resides outside San Diego, requested the facility's assistance, it was the facility's responsibility to assist R1 with Medi-Cal appointments to resolve the issue. A1 also mentioned that the Medi-Cal program was ultimately renewed through the Care Coordinator Agency Libertana on July 1, 2024. Additionally, on May 7, 2026, the department interviewed three staff members (S1-S3), all of whom denied the allegation. It indicated that they care for the residents but lack knowledge of their finances. Three residents (R2-R4) were also interviewed; they expressed satisfaction with their living situation and reported no issues regarding their Medi-Cal or financial matters. Report Continued on LIC9099C The department also interviewed the responsible party (RP), who denied the allegation and confirmed that the facility was a tremendous help to R1. The RP, residing outside San Diego, noted the challenges of being present all the time. The RP stated that there was no financial abuse and that they had specifically asked the facility to assist in taking R1 to the appointment and to provide any necessary assistance. The department records review of ALW and Medi-Cal on May 7, 2026, confirmed that R1 was a program member. Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited. An exit interview was conducted. A copy of this report was provided to the Administrator, Dearme Dovertethe state’s words, verbatim · CDSS document, May 7, 2026 · control 18-AS-20240403234637

Type of visit: Required - 1 Year

On 7/25/24 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility for the purpose of conducting a 1 year required visit/annual inspection. LPA George met with Dearme Doverte, Administrator and informed of the purpose of today's visit. The facility is licensed to serve 10 non ambulatory residents, ages 60 and above, and approved to have up to 10 bedridden residents. The facility has an approved hospice waiver for (6). There are currently (2) residents receiving hospice services. Below is a summary of what was observed during today’s inspection: Infection Control: LPA George observed that the facility has an updated Infection Control Plan on file and is demonstrating best practices in the facility to maintain a healthy environment for staff and residents. The facility was observed to have an adequate supply of Personal Protective Equipment (PPE) supplies. Physical Plant: LPA toured the interior and exterior of the facility and observed that there a sufficient bedrooms and bathrooms for both staff and residents. The facility was observed to have the required furniture and linen to be present and in good condition in resident bedrooms. The exits are not obstructed and that there is plenty of space for activities. The facility was observed to have operable flashlights. There are no pools or bodies of water on the premises. Records Review-Staff Records: LPA George confirmed that there is an Administrator present with a valid Administrator certificate. LPA George confirmed staff have criminal record clearance and were associated to the facility and have training to perform their required duties. All staff present at have current CPR/First Aid Certification. Resident Records: A review of all (4) current residents to confirm that they have the required information present in their files, including Physician's Report, Admissions Agreement, and current Needs & Services Plan. Food Services: The kitchen and dining area to be maintained in a clean and healthful manner. Sufficient dishware and silverware were present for resident’s use. LPA George observed the facility to have the required amount of 7 day supply non-perishable and a two supply perishable food items. Medication: Resident medication was observed to be locked in the cabinet next to the refrigerator and inaccessible to residents in care. The facility is utilizing an electronic program Alcomy, in addition to using a hard copy of the Medical Authorization Record (MAR). Emergency Disaster Preparedness: The facility has an Emergency Disaster Plan on file and conducts regular disaster drills on a quarterly basis. The last drill was conducted on 07/01/24. The dual smoke and carbon monoxide detectors were tested and were found to be operable. The facility has (3) fully charged fire extinguishers. There are no known guns or ammunition on the premises. After the hot water heater was adjusted the hot water was tested and was found to be within regulatory limits. The facility has emergency food and water supply. The sharps and hazardous chemicals were observed to be locked and inaccessible to residents in care. The facility will provide the following documents for the facility file at the Regional Office: -LIC 500 Personnel Report -Updated facility sketch (office, and caregiver room) small garage -Liability insurance Based on today's inspection there were no deficiencies cited. An exit interview was conducted and a copy of this report, were provided to Dearme Doverte, Administrator.the state’s words, verbatim · CDSS document, Jul 25, 2024