Arc Facility at Camino 2

Allegation investigated: Staff allowed residents to be left in soiled clothing for an extended period of time

On 08/14/2026, Licensing Program Analyst (LPA) Pang Lee conducted a telephone meeting with Facility Designated Administrator (FDA) Michael Adams for the purpose of delivering the complaint finding regarding the allegation above. A brief interview was conducted with FDA Adams. It was alleged that staff allowed residents to be left in soiled clothing for an extended period of time. During the course of the investigation, the Department conducted interviews and requested relevant facility records. FDA Adams denied the allegation and stated that facility staff provide residents with routine incontinence care, including changing and showering residents as needed. FDA Adams further stated that residents are routinely checked every two hours and stated that the facility does not document when residents are changed. The Department was able to interview two residents. One of the two residents denied the allegation and reported no concerns regarding care provided by facility staff. CONTINUED LIC 9099-C Unsubstantiated An outside agency was also contacted and stated that they did not recall the alleged incident. Attempts were made to contact the complainant; however, that attempt was unsuccessful. On 06/20/2026, LPA Lee emailed FDA Adams requesting facility records for review. On 07/31/2026, LPA Lee contacted FDA Adams by telephone to follow up regarding the requested records; however, the requested records were not provided to the Department. Based on interviews conducted and the information obtained during the investigation, there is insufficient evidence to establish that staff allowed residents to remain in soiled clothing for an extended period of time. As a result of this investigation, this Department found the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegation may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. An Exit Interview was conducted with FDA Adams, and a copy of this report was provided to the facility via email. A certified copy will be sent to the facility mailing address.the state’s words, verbatim · CDSS document, Aug 14, 2026 · control 22-AS-20240625110839

Type of visit: Case Management - Deficiencies

On May 4, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Deficiencies visit. LPA was greeted and granted entry into the facility by Administrator Michael Adams (AD) after explaining the purpose for the visit. LPA is conducting the visit to follow up on a deficiency that was cited during the facility's annual inspection conducted on January 26, 2026. During the annual inspection, the facility was issued a citation under California Code of Regulations Section 87205(b). The regulation states, "(b) If the licensee is a corporation or an association, the governing body shall be active, and functioning in order to assure accountability." The basis for the citation is that the Licensee of the facility, Adams Residential Care Facilities LLC, is no longer active and was suspended on December 1, 2011. Based on records reviewed during today's visit, LPA observed that the Licensee, Adams Residential Care Facilities LLC, is still inactive. The facility has also not submitted a Change of Ownership application to the Centralized Application Bureau (CAB), as initially agreed upon. Based on the information gathered during today's visit, a deficiency is being recited on the attached LIC809-D page. An exit interview was conducted with Administrator Michael Adams. A copy of the report and appeal rights were provided at time of visit.the state’s words, verbatim · CDSS document, May 4, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87205(b) · Plan of correction due date: May 11, 2026

(b) If the licensee is a corporation or an association, the governing body shall be active, and functioning in order to assure accountability. This requirement is not met as evidenced by: Based on records reviewed, the licensee did not comply with the section cited above which poses an potential health, safety and personal rights risk to persons in care. LPA observed that the licensee, Adams Residential Care Facilities LLC, is not active and was suspended on 12/1/11.the state’s words, verbatim · CDSS document, May 4, 2026

Plan of correction: The Administrator stated that he will be submitting a change of ownership application to the centralized application bureau. The Administrator agreed to provide LPA proof of application submission via email or fax by POC date.

Type of visit: Case Management - Deficiencies

On March 2, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Deficiencies visit. LPA was greeted and granted entry into the facility by Administrator (AD) Michael Adams after explaining the purpose for the visit. The purpose for today's visit was to follow up on the deficiencies that were cited during the facility's annual inspection conducted on January 26, 2026. During today's visit, LPA reviewed the four residents files. All the required documentation was present and current in the resident files reviewed. LPA observed the facility is up to date on their annual fees. LPA observed the AD submitted all the required documentation for the plans of corrections. Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. Additionally, all deficiencies that were cited during the facility's annual inspection were cleared during today's visit. An exit interview was conducted with Administrator (AD) Michael Adams and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 2, 2026

Type of visit: Required - 1 Year

On January 26, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Michael Adams was notified via telephone but was unable to assist with today's inspection. LPA observed that Michael Adams does not have a valid Administrator certificate on file, and that there is no pending application at this time. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for two. The facility is a single-story home with three resident bedrooms, two of which are shared, one staff room, two resident bathrooms, a living room, a dining room, a kitchen, and an attached three car garage. LPA accompanied by a care giving staff conducted a tour of the interior portion of the facility. On today's visit, LPA observed four residents in care and two staff present. LPA observed residents relaxing in the living room and in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall by the entryway of the facility. LPA inspected all three resident bedrooms, and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. All resident beds had clean linens and blankets. LPA observed additional linens are stored in a hallway closet. LPA observed the staff bedroom is kept locked and inaccessible to residents in care. LPA inspected the two resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 116.3 and 119.6 degrees Fahrenheit. LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. CONTINUED ON LIC809-C LPA observed kitchen appliances to be clean and operational. The five burner gas stove lights unassisted. LPA observed kitchen knives and sharps are stored in a locked kitchen cabinet. A fire extinguisher is located in the dining room and it was observed to be charged and up to date on service. LPA tested the individual smoke detectors and carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on December 1, 2025. The centrally stored medication is kept in a locked kitchen cabinet. LPA observed a First Aid kit stored in the closet by the resident hallway. The First Aid kit was observed to have all the required components. The door leading to the attached three car garage is kept locked and inaccessible to resident in care. LPA observed the three car garage is used for storage and for laundry. LPA observed chemical and toxins to be stored in the garage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA, accompanied by a care giving staff, conducted a tour of the exterior portion of the facility. LPA observed the exterior portion to be clear of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gates of the facility are self-latching and can be opened in an evacuation. LPA observed a pool located in the backyard which is adequately fenced and kept locked for resident safety. LPA reviewed all four resident files. LPA observed that there was no Medical Assessment on file for Resident #1 (R1). LPA observed that the Reappraisal on file for Resident #3 (R3) was outdated. LPA reviewed four residents’ medication and medication administration records. LPA reviewed two staff files. All staff are background cleared and associated to the facility. LPA observed that the licensee, Adams Residential Care Facilities, LLC, is not active and was suspended on December 1, 2011. LPA also observed that the annual fees for the facility were not paid in 2024 or in 2025. The AD was advised that if the annual fee are not being paid, it may result in forfeiture of the license. Based on today's observations, deficiencies are being cited on the attached LIC809-D pages. An exit interview was conducted via telephone with Administrator Michael Adams. A copy of the report and Appeal Rights were provided to an authorized facility representative.the state’s words, verbatim · CDSS document, Jan 26, 2026

Allegation investigated: Facility staff yell at residents Facility does not provide residents with nutritious meals Residents not afforded privacy when visiting with family Facility is not clean and well maintained

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation into the allegations listed above. LPA met with Administrator Mike Adams and explained the reason for the visit. The investigation into the allegation, facility staff yell at residents revealed the following. Resident 1 (R1) and Witness 1 (W1) reported that on numerous occasions in February and March of 2024 the Administrator yelled at R1. Staff interviewed reported that they had heard the Administrator yell, but they did not know if they were yelling at residents. The Administrator reported that they raised their voice to residents during discussions but didn’t think it was yelling. 2 out of 6 residents interviewed reported that they have heard the Administrator yell at residents. All witnesses interviewed reported that these incidents have happened in February and March 2024. The preponderance of evidence standard has been met therefore the allegation is substantiated. Substantiated The investigation, into the allegation, facility staff handle resident roughly when transferring causing pain, revealed the following. It was reported that when staff transfer Resident 1 (R1) they handle R1 in a rough manner that causes pain. Staff 1 and Staff 2 reported that R1 complains of pain when moving no matter how gently they assist. R1 reported that most movement causes them pain. The Administrator reported that no matter how slowly they assist or move R1 they complain of pain. The Home Health Nurse reported that R1 reports pain any time they are moved and assisted and they have observed staff and everything is being done to assist R1 in a safe comfortable manner. The Home Health Nurse reported that there doesn't seem to be a medical reason for the pain reported by R1 and they advised staff to be careful and gentle when moving R1. Based on the evidence gathered, the allegation is deemed 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. The investigation, into the allegation, resident developed a pressure injury while in care, revealed the following. Resident 1 (R1) moved into the facility December 16, 2023 and moved out of the facility on August 21, 2024. It was reported that R1 had a pressure injury that was caused by facility staff assisting R1 which caused them to remain in bed most of the time. R1 reported they enjoyed staying in watching TV. The Administrator reported they assist R1 into and out of bed every time they request it, R1 verified this report. Staff 1 and Staff 2 reported they always assist R1 into and out of bed when requested. The Home Health Nurse reported that R1 did have redness on the lower back but it never developed into a pressure injury and it was resolved. The Administrator reported that R1 had continuous Home Health visits for the duration of their stay. There is no record of R1 being diagnosed with a pressure injury. Based on the evidence gathered, the allegation is deemed 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. The investigation into the allegation, facility staff does assist residents with providing transportation for medical appointments, revealed the following. It was reported that the staff never have R1 ready to go to their medical appointments and when the transportation arrives R1 is not ready. Transportation cannot wait for R1 therefore they leave the facility and R1 ends up missing their appointment. Staff 1 and Staff 2 reported that R1 is always ready to go but R1's responsible party causes the delays and has changed the appointments at the last minute which has caused problems. The Administrator reported that R1 is always ready to go but R1's responsible party has caused issues by asking for R1's clothes or hair to be changed at the last minute, when R1 was already prepared to go. R1's responsible party denies the allegations. R1's responsible party reported that staff never have R1 ready to go but did not provide any specific details. R1 would not answer any questions regarding their missed appointments. LPA contacted the transportation driver but never received a response. Based on the conflicting information received, it can't be determined what actually transpired when R1 had medical appointments. Based on the evidence gathered, the allegation is deemed 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. The investigation into the allegation, facility staff do not perform proper hand hygiene while working, revealed the following. It was reported that the Administrator and Staff 1 (S1) do not regularly wash their hands after assisting residents. 1 out of 6 residents interviewed reported they never see the Administrator or S1 wash their hands. S1 and the Administrator denied the report and stated they wash their hands after assisting each resident. No specific details were provided as to dates and times or incidents when facility staff did not wash their hands. There is no evidence to support the allegation, therefore the allegation is unsubstantiated, meaning 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. An exit interview was conducted and a copy of the report provided. The investigation into the allegation, facility does not provide residents with nutritious meals revealed the following. The facility has a posted menu in the kitchen, but the menu is not followed. The meals listed for March 18, 2024, were not followed. Residents and staff interviewed reported that on March 18, 2024, residents had cereal and milk for breakfast, no other items were mentioned. LPA observed ground beef tacos being served for dinner, but there was not side dish of a vegetable, rice or potatoes. The only item was the main entrée. To drink there was milk, water or soda. No dessert item was served. A variety of food must be served that meets the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. Breakfast and dinner did not have all the required food groups, and no fruits or vegetables were offered. Staff and residents interviewed reported that in between meal snacks were offered. Snacks offered were crackers and cookies. 3 out of 6 residents reported that water is always available. The preponderance of evidence standard has been met, therefore the allegation is substantiated. The investigation into the allegation, residents not afforded privacy when visiting with family, revealed the following. It was reported that during a visit with Resident 1 (R1) and their family the Administrator walked into the room unannounced and interrupted the visit. The incident was reported to have taken place on June 24, 2024. The Administrator reported that they did walk into R1’s room unannounced and had issues they needed to discuss with R1. The Administrator reported that they apologized and there have been no further incidents. R1 and W1 verified this information. The Administrator, R1 and W1 all reported the incident took place on June 24, 2024. Based on the evidence gathered the preponderance of evidence standard has been met, therefore the allegation is substantiated. The investigation into the allegation, facility is not clean and well maintained revealed the following. It was reported that the facility is in disrepair, and the facility has torn carpet in the living room, paint is chipping the kitchen and dining room, the kitchen cabinet doors are broken and the vanity in the bathroom in the hallway is broken. LPA observed during the initial 10-day visit all the items mentioned above need repair. The carpet is torn, the bathroom vanity is broken and has cracked wood, the kitchen cabinet doors need new hinges and don’t close properly and the paint in the kitchen and dining room is chipped. LPA observed the kitchen is not clean there was food debris on the kitchen counter and in the storage drawers. LPA observed the kitchen stove is not clean and has grease and dirt on it. Based on the evidence gathered the preponderance of evidence standard has been met, therefore the allegation is substantiated. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations, an exit interview was conducted and a copy of the report provided along with appeal rights.the state’s words, verbatim · CDSS document, Nov 13, 2025 · control 22-AS-20240308170533

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Nov 14, 2025

To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not being met as evidenced by. The Administrator has yelled at residents as reported by staff and residents, this poses an immediate personal rights violation to residents in care.the state’s words, verbatim · CDSS document, Nov 13, 2025

Plan of correction: The Administrator agrees to not yell at residents and to sign a statement of understanding for CCR 87468.1 and submit proof to LPA by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Nov 14, 2025

To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement is not being met as evidenced by The Administrator walked in R1's room without notice on June 24, 2024, which poses an immediate personal rights violation to residents in care.the state’s words, verbatim · CDSS document, Nov 13, 2025

Plan of correction: The Administrator agrees to not interupt and not to walk into residents rooms without notice. Administrator agrees to sign a statement of understanding for CCR 87468.2 and submit proof to LPA by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(5) · Plan of correction due date: Nov 20, 2025

Meals shall consist of an appropriate variety of foods and shall be planned with consideration for cultural and religious background and food habits of residents. This requirement is not being met as evidenced by... The facility does not serve a variet of foods as observed by the LPA. This poses a potentional, health, safety and personal righst risk to residents in care.the state’s words, verbatim · CDSS document, Nov 13, 2025

Plan of correction: The Licensee agrees to update the facility menu and to serve a variety of foods and to have each meal be well balanced. Licensee to submit a statement of understanding of CCR 87555 to LPA by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Dec 4, 2025

The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not being met as evidenced by LPA observed the facility has torn carpet in the living room, paint is chipping the kitchen and dining room, the kitchen cabinet doors are broken and the vanity in the bathroom in the hallway is broken. This poses a potential, health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 13, 2025

Plan of correction: Licensee agrees to fix, repair and clean all items mentioned in the report and to submit proof of the repairs to the LPA by the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by Administrator (AD) Michael Adams after explaining the purpose for the visit. LPA observed that Michael Adam's Administrator Certificate expired on July 24, 2024. However, LPA verified and confirmed that AD submitted his renewal application to the Administrator Certification Bureau (ACB) on 07/24/2024. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for two. The facility is a single-story home with three resident bedrooms, two of which are shared, one staff room, two resident bathrooms, one of which is shared, a living room, a dining room, a kitchen, and an attached three car garage. LPA accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed four residents in care, none of which are receiving hospice care, and two staff present. LPA observed residents relaxing in dining room and in the living room. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall by the entryway of the facility. LPA inspected all three resident bedrooms, and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. All resident beds had clean linens and blankets. LPA observed additional linens are stored in a hallway closet. LPA observed that staff room is kept locked and inaccessible to residents in care. LPA inspected the two resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 110.3 and 114.6 degrees Fahrenheit. LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. CONTINUED ON LIC809-C LPA observed kitchen appliances to be clean and operational. The four burner gas stove lights unassisted. LPA observed kitchen knives are stored in a locked kitchen cabinet. A fire extinguisher is located in the dining room and it was observed to be charged and up to date on service. LPA tested the individual smoke detectors and carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on January 25, 2025. The centrally stored medication is kept in a locked kitchen cabinet. LPA observed a First Aid kit stored in the closet in the resident hallway. The First Aid kit was observed to have all the required components. The door leading to the attached three car garage is kept locked and inaccessible to resident in care. LPA observed the three car garage is used for storage and for laundry. LPA observed chemical and toxins to be stored in the garage. LPA observed the facility has a three day emergency water supply stored in the garage. LPA observed the facility does not have a sufficient three day emergency food supply on hand. LPA and AD conducted a tour of the exterior portion of the facility. LPA observed the exterior portion to be clear of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate on the north side of the facility is self-latching and can be opened in an evacuation. LPA observed a pool located in the backyard which is adequately fenced and kept locked for resident safety. LPA reviewed all four resident files. LPA observed that the Reappraisals for Resident #1 and Resident #2 were outdated. LPA reviewed four residents’ medication and medication records. LPA observed that the facility did not have a record of centrally stored prescription medications for Resident #2. LPA reviewed two staff files. All staff are background cleared and associated to the facility. Based on today's observations, deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Michael Adams. A copy of the report was explained and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Feb 3, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility to conduct a Required - 1 year inspection. LPA identified herself and was granted entry into the facility by Administrator (AD) Michael Adams. AD's certificate expired on 07/24/2024. LPA verified/confirmed that AD has submitted his Renewal application. AD was advised the annual fee has not been paid and if not paid may result in forfeiture of the license. Five Residents and 2 staff were present during today's visit. LPA, along with AD Adams toured the physical plant. During the inspection, LPA confirmed all residents were doing well. LPA inspected common areas, dining room, resident rooms, kitchen, garage, and backyard. LPA observed hallways were free of obstruction. The home is maintained at a comfortable temperature. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each Resident comfortably. Bathrooms were checked and both require a deep cleaning; hallway bathroom has a water leak under the sink. Hot water temperature is within regulatory requirements. Bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas, garage, kitchen, dining room, food pantry, refrigerator need to be cleaned and organized. Facility lacks a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. LPA observed sharps and cleaning supplies are inaccessible to the residents. Smoke detectors and carbon monoxide detector tested operational. Fire extinguisher was last serviced a couple years ago per AD. There is a built in pool and pool gate was latched but does not have a lock. Walkway near garage has some clutter. Backyard has patio table with chairs and an umbrella for Residents and visitors. Emergency/Fire Drill was last conducted on 04/23/2024. LPA reviewed 5 Resident files and one staff file. Medication was observed to be in a centrally stored location and medication reviewed appeared to have been dispensed accurately. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of LIC809, LIC809D, LIC9102 and Appeal Rights were sent to email on file.the state’s words, verbatim · CDSS document, Nov 4, 2024

Allegation investigated: Facility is mismanaging medication

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegations above. LPA and the Administrator toured the facility. LPA interviewed staff and residents. The investigation into the allegation facility is mismanaging medication revealed the following. It was reported that Resident 1 (R1) ran out of their Venlafaxine 225MG. R1 verified they ran out of the medication on or around July 14, 2024. The Administrator verified this report. At this time the facility was handling R1's medication. Both the Administrator and R1 verified this information. A review of medication records show R1's medication arrived at the facility on July 31, 2024. R1 did not have their Venlafaxine 225MG for 16 days. LPA reviewed R1's medication. No other discrepancies observed. Based on the information gathered the preponderance of evidence standard has been met therefore the allegation is substantiated. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulation. An exit interview was conducted and a copy of the report provided along with appeal rights was provided. Substantiatedthe state’s words, verbatim · CDSS document, Aug 6, 2024 · control 22-AS-20240730135947

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(16) · Plan of correction due date: Aug 7, 2024

To receive or reject medical care or other services. This requirement is not being met as evidenced by... R1 ran out of their Venlafaxine 225MG for 16 days which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 6, 2024

Plan of correction: Licensee agrees to retrain staff on medication management. Licensee agrees to set policies in place to properly have medication reordered prior to residents running out of medication. Licensee to submit proof of training and a new medication policy to LPA.

Allegation investigated: Staff refuses to assist resident with transfers

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with the Administrator Mike Adams and explained the reason for the visit. The investigation into the allegation revealed the following. LPA interviewed Resident 1 (R1). R1 reported that the Administrator refused to assist them transfer out of bed since they are non-ambulatory. The Administrator verified this report. R1 and the Administrator reported that the fire department was called and they responded to the facility on July 24, 2024. R1 and the Administrator verified that R1 was transferred with the help of the firemen on July 24, 2024. The Administrator reported that at the time they could not assist R1 because of back issues. Based on the evidence gathered through interviews the preponderance of evidence standard has been met therefore the allegation is substantiated. Deficiencies are cited are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report was provided along with appeal rights. Substantiatedthe state’s words, verbatim · CDSS document, Jul 25, 2024 · control 22-AS-20240718090547

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(4) · Plan of correction due date: Jul 26, 2024

Basic Services. Basic services shall at a minimum include: Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal with those activities of daily living such as dressing, eating, bathing... , as specified in Section 87608...This requirement is not being met as evidenced by: Based on interviews the Administrator did not transfer R1 on July 24, 2024 when they requested to be transferred, This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 25, 2024

Plan of correction: Licensee agrees to transfer all residents when they request assistance. LIcensee agrees to submit a statement of understanding for CCR 87464 Basic Services.

Type of visit: POC

On this day Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. made an unannounced Plan of Correction (POC) visit in conjunction with complaint control #22-AS-20240116114800 and citation issued on 01/25/2024. LPA was greeted and granted entry into the facility by Administrator (AD) Michael Adams and explained the reason for the visit. On 01/26/2024, AD failed to correct the following: Deficiency cited under Title 22 Regulation 87208 (a)(12) pertaining to Plan of Operation (The Infection Control Plan). As of 03/14/2024, Deficiency cited under Title 22 Regulation 87208 (a)(12) pertaining to Plan of Operation (The Infection Control Plan) has been CLEARED. Licensee has read regulation and sign a statement of understanding. Licensee has complied with the terms of the POC. LPA Ramirez conducted an exit interview with AD Adams and a copy of this report and Letter of Cleared Deficiency has been provided to the facility.the state’s words, verbatim · CDSS document, Mar 14, 2024

Allegation investigated: Facility is not abiding by Infection Control plan

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegation and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and met with Administrator (AD) Michael Adams. LPA explained the reason for the visit. On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: During the investigation LPA reviewed documents including the ARC Facility At Camino 2 Plan for Epidemic Outbreak to Covid-19 Mitigation Plan Report dated 12/2020. Per Plan for Epidemic Outbreak to Covid-19 Mitigation Plan Report on page 10 of 28 under Staff it states if staff must cross between designated Covid-19 unit and clear zone, they will be fully trained on appropriate use of PPE. During the initial visit LPA observed that Staff 1 (S1) was not wearing a mask. Per Plan for Epidemic Outbreak to Covid-19 Mitigation Plan Report on page 5 of 28 under Visitors CONTINUED ON LIC9099-C... Substantiated it states facility has a visitation plan. Records reviewed by LPA Ramirez included the Provider Information Notice (PIN) number 23-13-ASC dated 06/15/23. Per PIN number 23-13-ASC under Visitation it states that for residents in isolation, the licensee should provide the visitor with the same type of Personal Protective Equipment (PPE) used by facility staff. During the course of the interviews AD stated that recently Resident 1 (R1) who is in isolation had a window visit. Per AD the last thing he knew was that visitors were not allowed into the facility. Based on the interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation: facility is not abiding by Infection Control plan is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted with AD Adams and a copy of this report along with the Appeal Rights were provided at the time of this visit. care for the residents. Based on LPA's observation and information gathered during the investigation, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed UNSUBSTANTIATED. LPA Ramirez conducted an exit interview with AD Adams, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jan 25, 2024 · control 22-AS-20240116114800

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87208(a)(12) · Plan of correction due date: Jan 26, 2024

Plan of Operation (a)Each facility shall have and maintain a current, written definitive plan of operation...The plan and related materials shall contain the following:(12)The Infection Control Plan pursuant to Section 87470. This requirement was not met as evidence by: Based on LPA observations S1 was not wearing Personal Protective Equipment (PPE) during the initial visit. Based on interviews conducted R1 was not allowed to have an in-person visit. This poses an immediate risk to resident’s health and safety.the state’s words, verbatim · CDSS document, Jan 25, 2024

Plan of correction: Licensee/Administrator agrees to read regulation and sign a statement of understanding and forward proof to LPA by POC due date.