Ardent Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with Jessa Valdez for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 02:00 PM and the following was noted: There is one entrance being utilized at the facility. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for storage and laundry. The facility is fire cleared for six (06) non-ambulatory, of which two (02) may be bedridden, and a hospice waiver for six (06). The facility is currently occupying four (04) residents. The facility has a total of five (05) bedrooms for residents and two (02) bathrooms. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 78°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located between the living room and hallway, observed to be fully charged and last inspected 09/9/2025. (CONT. on LIC809-C) Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 116.8°F. Laundry detergents, cleaning agents and other toxins are locked away. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication to be locked and inaccessible to residents. Facility maintains a complete first aid kit. Incomplete records addressed with the Licensee (see LIC809-D) Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): No other health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 2, 2025

Allegation investigated: Staff neglect resulted in a resident sustaining pressure injuries while in care. Staff neglect resulted in a resident to be hospitalized. Staff did not meet a resident's incontinence needs while in care.

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with Jesse Valdez and explained the reason for the visit. ---Staff neglect resulted in a resident sustaining pressure injuries while in care. ---Staff neglect resulted in a resident to be hospitalized. ---Staff did not meet a resident's incontinence needs while in care. It was alleged that staff did not meet Resident #1's (R1) incontinence needs which resulted in pressure injuries and hospitalization. To investigate the allegations on 03/14/2025 LPA requested documents at around 10:00a.m., interviewed three (03) staff from 11:30a.m. to 1:00p.m. and interviewed two (02) out of three (03) residents from 1:00p.m. to 1:30p.m. (CONT. on LIC 9099-C) Unsubstantiated A review of hospital records indicates that R1 was admitted to the hospital on 02/10/2025 with Generalized weakness and Low back, bilateral buttock, and perineal skin breakdown. Hospital records also indicate R1 has a pertinent medical history of advanced urinary incontinence, rashes on back and buttock area. Physicians Report indicates resident is not bedridden, ambulatory and requires incontinent care. During interviews with staff, all staff stated residents are checked on every one (01) to two (02) hours, are changed minimum six (06) times a day or more if needed and are not left soiled for an extended time. Staff #1 (S1) added R1 is not bedridden, that facility provides adequate incontinent care to all requiring residents and checks on residents frequently. During interviews with residents, all residents, including R1, stated they feel staff are meeting their needs, meeting their incontinent needs and are not leaving them soiled for an extended time. Based on interviews and record review, there is not enough information to verify the allegation. Therefore the allegation is UNSUBSTANTIATED at this time. No health and safety hazards noted during the visit. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Jun 26, 2025 · control 31-AS-20250313114301

Allegation investigated: Staff did not provide records to resident's authorized representative.

Licensing Program Analysts Abeye Duguma and Angelica Segovia conducted an unannounced initial complaint visit to the facility. Upon arrival LPAs met Roilann De Guzman and explained the reason for the visit. --- Staff did not provide records to resident's authorized representative. It was alleged that requests started in May 2024 and to this day requesting party has not received all documents. To investigate the allegation, on 11/07/2024 at around 10:00a.m. LPA conducted interviews with other parties, requested records at around 11:00a.m. and interviewed the administrator Roiland De Guzman from around 11:15a.m. to 11:45a.m. During interviews with other parties, they stated ALL records were requested on 05/14/2024 and 10/04/2024 however facility only sent partial documents such as Physician’s Report, Care Plan and Admission’s Agreement. (CONT. on LIC9099-C) Substantiated A review of records revealed that requesting party sent legal power of attorney documentation and a letter requesting ALL documents on 05/14/2024 and 10/04/2024. A review of facility records revealed facility was in possession of other documents that were NOT sent such as Consent Forms, Personal Rights, Centrally Stored Medication Destruction Record and I.D. and Emergency Information. During interview with the Administrator, they confirmed that only the Physician’s Report, Care Plan and Admission’s Agreement were sent to the requesting party and did not know they were supposed to send other documents in their possession. Based on interviews and record review, there is enough information to verify the allegation, therefore, the allegation is SUBSTANTIATED at this time. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D): No other health and safety hazards noted during the visit. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 7, 2024 · control 31-AS-20241101125517

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(19) · Plan of correction due date: Nov 9, 2024

87468.2 (19) Additional Personal Rights of Residents in Privately Operated Facilities-To have prompt access to review all of their records and....shall be provided within two (2) business days…This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not ensure all records were provided to the responsible party which poses a potential personal right violation to residents in care.the state’s words, verbatim · CDSS document, Nov 7, 2024

Plan of correction: The Administrator will review regulation 87468.2 (19) Additional Personal Rights of Residents in Privately Operated Facilities and submit a written statement ensuring that they will adhere them and submit all missing documents to the responsible party by the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with Jayson Guevarra for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 8:30 AM and the following was noted: There is one entrance being utilized at the facility. The facility has a total of five (05) bedrooms for residents and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory, of which two (02) may be bedridden, and a hospice waiver for six (06). The facility is currently occupying six (06) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for storage and laundry. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 76°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located between the living room and hallway, observed to be fully charged. (continued on LIC 809-C) The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 113.5°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication to be locked and inaccessible to residents. Facility maintains a complete first aid kit. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 7, 2024