Arcadian Shores Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Administrator Rita Herrera and was granted entry to the facility. At the time of the visit there was one (1) staff present, and two residents were attending Day Program. The facility is a four (4) bedroom, two (2), bathroom home, with a kitchen/dining area, living room, with an attached garage. The facility is a Residential Care Facility for Elderly (RCFE) level 2 vendorized by Inland Regional Center. Licensed capacity is (6) current census (2). LPA was accompanied by Facility Administrator, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected residents’ bedrooms; they are equipped with required furniture such as mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside staff office inaccessible to residents in care. Overall, the facility is clean, in good repair, and operates in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed two (2) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Fire and disaster drills were completed on 6/30/26. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator Rita Herrera.the state’s words, verbatim · CDSS document, Jul 31, 2026

Allegation investigated: Facility staff do not ensure facility stove is in good repair

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Caregiver Clarita Pereabras and explained the purpose of the visit. The investigation consisted of interviews and observations. First allegation: Facility staff do not ensure facility stove is in good repair. Regarding the first allegation “facility staff do not ensure facility stove is in good repair” LPA conducted an inspection on facilities appliances and LPA discovered that the stove oven was in despair. LPA conducted an interview with Staff#1 who informed LPA that the oven has been out for approximately two-months. LPA tested the top stove burners and observed that all four burners were in working condition. LPA conducted an interview with Facility Administrator who informed LPA that a new stove has been purchased. Based on the evidence along with the observation, the above allegation Substantiated. Substantiated Substantiated: A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations, 87303 Maintenance and Operation, from division 6, chapter, article 6, is being cited on the attached LIC 9099 D. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided, along with a copy of the appeal rights. to Facility Caregiver Clarita Pereabras.the state’s words, verbatim · CDSS document, Dec 4, 2024 · control 56-AS-20241126113036

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303 · Plan of correction due date: Dec 13, 2024

87303 Maintenance and Operation.... (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidence by: Based on observation, interviews, the licensee did not ensure facility stove oven to be in good repairs according to Maintenance and Operation regulation, which can pose a potential health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 4, 2024

Plan of correction: Licensee has agreed to read over “Maintenance and Operation” regulation and provide training to staff all staff regarding the regulation and ensuring that facility shall be always in good repair. Licensee will provide LPA Guerrero with a copy of training signed and acknowledged by all staff by POC date 12/13/2024. In addition, licensee will also provide pictures/and or invoices of the stove being repaired or replaced by the POC date provided

Allegation investigated: Staff did not seek timely medical care for resident in care Staff did not notify resident's responsible person of resident's change of condition

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Caregiver Clarita Pereabras and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records. First allegation: Staff did not seek timely medical care for resident in care. Regarding the first allegation “Staff did not seek timely medical care for resident in care” LPA conducted an interview with Facility Administrator LPA was informed by Facility Administrator that Resident#1 had sustained an unwitnessed fall on 9/22/2024. Administrator informed LPA that paramedics were called to evaluate resident, and R#1 declined to be taken to the hospital. Administrator informed LPA that after the incident Resident #1 was not able to fully lift their arm. Administrator informed LPA that Resident#1 remained in that unable state for approximately a week before resident was taken to the hospital by R#1 Responsible Party. Second allegation: Staff did not notify resident's responsible person of resident's change of condition. Substantiated Regarding the allegation “Staff did not notify resident's responsible person of resident's change of condition” LPA conducted an interview with Facility Administrator who informed LPA that Resident #1 had sustained an unwitnessed fall on 9/22/2024. In addition, Administrator informed LPA that staff noticed that R#1 was not able to fully lift their arm up for about a week. During the interview LPA was informed by the administrator that R#1 was taken to the hospital by R#1 responsible party, who later was informed by Kaiser, that R#1 had sustained a Hemerus Fracture due to an accidental fall R#1 sustained on 9/22/2024. Based on the interviews and evidence gathered above allegations are Substantiated. Substantiated: A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations, 87465 (2) Incidental Medical and Dental Care, 87411 (a) Personnel Requirements – General, from division 6, chapter, article 6, is being cited on the attached LIC 9099 D. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided, along with a copy of the appeal rights. to Facility Caregiver Clarita Pereabras. Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Clarita Pereabras at the end of the visit.the state’s words, verbatim · CDSS document, Dec 4, 2024 · control 56-AS-20241030093600

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(2) · Plan of correction due date: Dec 5, 2024

Incidental Medical and Dental Care... 87465... (2)...The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the resident's need. In providing transportation the licensee shall do so directly or make arrangements for this service. This requirement is not met as evidence by: Based on interviews, record review, the licensee did not ensure Resident #1 received medical care on a timely manner, which poses a Health, Sefety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 4, 2024

Plan of correction: Licensee has agreed to read over “Incidental Medical and Dental Care” regulation and provide training to staff all staff regarding the regulation. Licensee will provide LPA Guerrero with a copy of training signed and acknowledged by all staff by POC date 12/5/2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Dec 5, 2024

Personnel Requirements – General... 87411.... (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidence by: Based on interviews, record review, the licensee did not follow "Personnel Requirements" to detect Resident #1 change of condition on a timely manner, which poses a Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 4, 2024

Plan of correction: Licensee has agreed to read over “Personnel Requirements – General” regulation and provide training to staff all staff regarding the regulation. Licensee will provide LPA Guerrero with a copy of training signed and acknowledged by all staff by POC date 12/5/2024.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with staff Clarita Pereabras and was granted entry to the facility. The facility is a (3) bedroom (2) bathroom home and, with a kitchen/dining area, living room, attach garage. Licensed capacity is (6) current census (2). LPA was accompanied by staff Clarita Pereabras to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The hot water temperature tested within regulation at 110 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (2) client file for admission agreements, updated physician reports, and needs and services plans. LPA also verified (2) medications. LPA also reviewed (1) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screening. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to staff Clarita Pereabras.the state’s words, verbatim · CDSS document, Aug 6, 2024