Ardenville Home Care I

Allegation investigated: Facility staff force fed resident(s) in care. Licensee did not keep residents free from intimidation or actions interfering with daily living functions. Licensee did not ensure residents were accorded dignity.

On Tuesday, 1/27/26, Licensing Program Analyst, (LPA) Raymond Comer conducted an unannounced subsequent visit to the facility to complete investigation of the allegations noted above. LPA conducted the initial complaint visit on 03/18/25. LPA met with facility DSP, Rosa Tuazon, who connected LPA with Administrator; DSP Rosa Tuazon was approved by Administrator to sign report on her behalf. LPA presented official CDSS badge identification, and reason for the visit was disclosed. At 1:35pm am, LPA conducted a physical plant tour; no health and safety issues were observed. To investigate the afformentioned allegations, on 03/18/25 at 12:10 pm, LPA conducted a physical plant tour; no health and safety issues were observed. Between 12:20 pm and 1:15 pm, LPA requested, and received facility residents roster, staff roster, and Residents records including Physician report, need and service plan, and other internal documents. Prior to this visit, on 01/21/26, LPA Comer reviewed facility records previously gathered at the facility. Between 1:25 pm and 2:15 pm, LPA interviewed... [LIC 9099C] Continued- Unsubstantiated the Administrator, Residents, and Responsible family members. Allegation: Facility staff force fed resident(s) in care. It was alleged that facility staff force-fed residents to eat, or force them to drink, while residents are trying to rest. Staff stated to LPA that residents’ meals are prepared and provided as instructed by the residents’ care plan. Staff are encourage residents to eat. However, no staff would ever force a resident to eat/drink against their will. Residents interviewed by LPA Comer during investigation denied being force-fed or forced to have drinks. LPA's review of facility records revealed the following: None of the facility's residents are required feeding assistance. Based on interviews, observation and record review, there is not sufficient information to support the allegation. Hence, the allegation is unsubstantiated at this time. Allegation: License did not keep residents free from intimidation or actions interfering with daily living functions. Allegation: License did not ensure residents were accorded dignity. It was reported that facility staff are waking up residents from their sleep, or while they are resting to make sure they eat and drink. Staff revealed that all residents are assisted before mealtimes for breakfast, lunch and dinner. Staff provide assistance to the residents to ensure they are clean and ready for meals. If residents choose not to get up to eat or drink, staff stated they let residents rest and offer meals at later time. No resident is being forced to get up against their will. Staff indicated that all residents are treated with dignity and respect. LPA interviews with Residents and Responsible Family Members revealed the following: Residents and Responsible Family Members denied disrespectful treatment or undesired assistance by staff. LPA's review of records did not provide any verifiable information to support the allegation. Therefore, based on interviews and record review, the allegations are unsubstantiated at this time. No health and safety issues were noted during this visit. Exit interview was conducted, and copy of report was issued.the state’s words, verbatim · CDSS document, Jan 27, 2026 · control 31-AS-20250313110749

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nadia Shahbazian conducted an Annual Required visit and inspection of the facility. LPA met Vicente Robles - Administrator and explained the reason for the visit. At 11:15am, with the assistance of Administrator, LPA took a tour of the physical plant. Required postings were observed in the dining area. The smoke/carbon monoxide detectors are hardwired and interconnected. At 11:40am, smoke and carbon monoxide detectors were tested and observed to function properly. The chime doors on each exit door, were observe to function properly as well. The fire extinguisher is located in the kitchen with charge date of 04/02/2025. Facility conducts quarterly fire drills; the last fire drill was conducted on 10/15/2025. Common Areas: These included the living room and dining room across from the kitchen and a sitting area at the front entry. The common areas were properly furnished with sofas, tables and chairs, appropriate for the number of residents. LPA observed several supply cabinets in the hallway. Laundry machine is located in the hallway and the laundry detergents were kept in locked cabinets atop the machines. LPA observed a bolted sliding door in the hallway; the door is completely shut and is inoperable. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient supply of perishable (2 days) and non-perishable (7 days) foods at the facility. All food supplies in containers were marked with purchase dates, to ensure food and safety regulations. Knives were stored in a locked drawer in the kitchen. All kitchen surfaces and appliances were clean and sanitary. Continued on 809-C Bedrooms: There were six (6) bedrooms designated for residents' use. All the bedrooms were properly furnished with appropriate furniture, beddings and linens with sufficient lighting. Three (3) of the bedrooms have exit doors. LPA observed the exit door in bedroom #1 to be obstructed by a cabinet; citation will be provided. Currently bedroom # 6 is vacant. Bathrooms: There are three (3) bathrooms, one (1) for staff use and two (2) designated for residents' use; bedroom #5 has it's own bathroom. Both resident bathrooms had required grab bars and non-skid mats. Hot water temperature was measured at 110.5 and 111.7 degrees Fahrenheit. Surrounding Grounds: There are two exits, one in the living room and one in the hallway, which are used as emergency exits, leading to the backyard. There was furniture appropriate for outdoor use, underneath a covered patio. The outdoor area was free of hazards and landscaping is maintained beautifully. There is no body of water in the premises. There is a detached garage, where additional emergency food, water and supplies are kept. Facility has an electrical generator, cable and internet access. Resident Files: LPA conducted a file review of all resident records to insure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and in compliance with licensing forms. Medications: A locked cabinet near the kitchen is used to store medications. Medications for three out of five residents were counted and Medication Records were reviewed for proper documentation and administration. Facility has two complete first aid kits and a first aid manual. Required Documents: Administrator license expiration date is 12/21/2025. Liability insurance for the facility has an expiration date of 07/02/2026. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies were cited (refer to LIC 809-D) during today's visit. Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued.the state’s words, verbatim · CDSS document, Oct 23, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alberto conducted the required annual inspection. LPA arrived unannounced and met with Administrator Vincent Robles who allowed entry of the facility and explained the purpose of the visit. Shortly after the Licensee Arden Robles arrived and assisted with the visit. The facility is licensed for residents ages 60 and over, may retain a maximum of four (4) hospice residents. Currently facility has 4 hospice residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. 2. Operational Requirement: The Infection Control Plan has been added to the Operation Plan. A Hospice Waiver for 4 residents is approved. Liability Insurance is updated and in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. 2 residents are currently bedridden according to most recent LIC602A. Facility is not licensed for any bedridden. 3. Physical Plant and Environmental Safety: The facility is a single-story house and located in a residential neighborhood area. The facility includes Dining area, kitchen, sitting room, six residents bedrooms, two resident bathrooms, one guest bathroom, laundry room, detached garage. Each resident bedroom has one bed, dresser, required beddings and furniture and sufficient lighting and closet space. The two residents bathrooms are clean, sanitary and in a good working condition. Both bathrooms have the required grab bar but not non-skid mat. The two bathrooms hot water temperature were tested between 112.2 and 116.4 degrees F. which is within the Tittle 22 regulation. All the appliances in the kitchen and living room are working well. The sharp knives are stored in a locked kitchen drawer. (Continue on 809C) All the cleaning supplies and chemicals are stored and locked in a cabinet in the laundry room area LPA observed the cabinet unlocked during visit. The linen and towels are stored in the hallway cabinet. The extra personal hygiene products are stored in the resident’s room. The carbon monoxide detectors were inspected, and they are working properly. The facility has table and chairs for resident to utilize outdoor activity. The Passageway, walkway and patio are free of obstruction. 4. Staffing: The facility has sufficient staffing, and the night supervision staff. 5. Personnel Record-Training: All the staff files are maintained in the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. All the direct care staff received Medication Management Training. The first aid training certificates for staff is current. 6. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, Pre-admission appraisal/Appraisal Needs & Services Plan. 7. Resident Rights-Information: The Complaint, ombudsman and CCLD poster and Residents personal rights are posted by the main entry. Visiting hours are included in admission agreement. 8. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 9. Food Service: The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be very clean and sanitary. The food is properly stored in the refrigerator (clean, labeled and well maintained). Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept very clean and free from rodents. 10. Incidental Medical and Dental: The medication is centrally stored and locked in the medication cabinet in the kitchen. six (6) centrally stored resident medications were reviewed, which contained 30-day supply of medications. R5 did not have doctor’s order or label. Family will provide transportation to resident for medical and dental appointment if needed. 11. Disaster Preparedness: The last fire drill was conducted on 07/02/24. Records of resident Appraisal and Needs services plans are part of Emergency training. The facility has an Emergency Disaster Plan (LIC610E) dated on 06/02/2007 that needs to be updated. The facility has two alternative temporary shelter location. 12. Resident with Special Health Needs: Two (2) residents are receiving home health services. four (4) receive hospice care. No resident is currently on postural support. Half and full bed rails for mobility assistance were observed in resident rooms without physician order. Individual Service Plans and Appraisals are on file. No residents have prohibited health conditions. Deficiencies observed during today’s visit. Technical Advisory provided. An exit interview was held. A copy of this report, two technical advisory notes, and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 12, 2024

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.