Argonaut Care Home 2

Allegation investigated: Staff did not provide medication assistance to resident in care as prescribed.

On 03-12-2026, Licensing Program Analyst, Arvin Villanueva (LPA), conducted a collateral visit at Argonaut Care Home, Inc, located at 860 Argonaut Drive, Jackson, CA 95642, to deliver complaint findings regarding the allegations noted above. LPA spoke with Shadea James over the phone and stated the purpose of this visit. Note that this facility is closed as of September 24, 2025. Throughout the investigation, the Deparment conducted interviews, record reviews and facility observation. Based on the investigation, the Department has made the follwoing determination. Allegation - staff did not provide medication assistance to resident, R1, as prescribed: Interviews and record reviews were completed. Staff stated that all medications are stored in a locked area that is only accessible to staff. Staff reported that medications are given as prescribed and provided copies of the Medication Administration Records (MARs) for review. Staff also provided screenshots of text messages between staff members, Patrick and Renae, and R1’s family members. In the text messages dated June 19, 2025 at 12:44 p.m., family stated that R1 fell backward in their wheelchair and complained of back and neck pain. Family also reported that R1 had diarrhea and soiled themselves that morning. Family expressed concern that R1 was being given Propylene Glycol routinely, even though it was ordered as needed for constipation. Family further stated that R1 told they were not receiving R1 6:00 a.m. morphine pill on time and sometimes had to wait until 7:00 a.m. or 8:00 a.m. Family confirmed that R1 told family that R1's 6:00 a.m. medication was often late and that had to ask staff for it. {1 of 2} Substantiated Patrick responded by text that the facility does not provide wheelchairs and that R1 was using a loaner wheelchair. Patrick stated that R1 no longer received Propylene Glycol after seeing R1's doctor. Patrick also stated that he spoke with staff and R1, and both confirmed that the 6:00 a.m. morphine was being given on time. Patrick reported that he set alarms to ensure medications were given on schedule. LPA reviewed the MARs from June 1, 2025 through August 1, 2025. Review of the June 2025 MAR showed that Famotidine 20 mg, ordered once daily, was not given from June 12, 2025 through June 30, 2025 due to the medication being “not available at the facility.” Gabapentin 300 mg, ordered daily, was not given on June 30, 2025, as there was no staff initial recorded. Morphine 15 mg, ordered every 4 hours, was not given on June 29, 2025 at 12:00 a.m., as there was no staff initial recorded. Potassium Chloride ER 10 mq, ordered once daily, was not given on June 29 and June 30, 2025, as there were no staff initials recorded. Review of the June 2025 MAR also showed that Miralax Powder (Propylene Glycol), ordered 17 grams once daily and to be held for loose stool, was documented as given daily from June 12, 2025 through June 30, 2025, as evidenced by staff initials. This documentation contradicts Patrick’s statement to family that R1 stopped taking this medication after doctor visit. Review of the July 2025 MAR showed that Miralax Powder continued to be given daily from July 1, 2025 through July 31, 2025, as evidenced by staff initials. LPA also reviewed a medication order dated June 5, 2025, for Morphine Sulfate 15 mg, ordered to be given one tablet every 4 hours. However, the MAR indicated that Morphine 15 mg was being administered every 6 hours, as shown by the recorded staff initials. This indicates the medication was not administered according to the physician’s order. Based on interviews and record review, the facility did not ensure medications were consistently available and administered as prescribed. In addition, there were discrepancies between staff statements and MAR documentation. Therefore, the allegation that staff did not provide medication assistance as prescribed is substantiated. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are cited on the 9099D during this visit. Exit interview conducted and a copy of this report and appeal rights were provided via email. {2 of 2} Allegation - staff did not seek timely medical attention for resident (R1): Con't LPA reviewed text messages dated June 19, 2025 at 12:44 p.m. between staff members Patrick and Renae and R1’s family members. In the messages, family stated that R1 fell backward in their wheelchair in the morning. Family reported that the wheelchair did not have an anti-tip feature and that R1 complained of back and neck pain. Family also stated that R1 had diarrhea and soiled self that morning while family was visiting. Family expressed concerns about medication and stated that R1 told that R1 was not receiving the 6:00 a.m. morphine pill on time. Family confirmed that R1 told the same concern about R1's medication being late. In response, Patrick stated by text that the facility does not provide wheelchairs and that R1 was using a loaner wheelchair until he could obtain one through his primary physician or purchase one on his own. Patrick stated that R1 no longer received Propylene Glycol after doctor visit. Patrick also stated that he spoke with staff and R1, and both confirmed that R1 was receiving his 6:00 a.m. medication on schedule. Patrick indicated that he set alarms to help ensure medications were given on time. Based on interviews and records reviewed, there is conflicting information regarding whether R1 fell or almost fell. Staff reported that R1 did not fall and that he was assessed right away with no injuries noted and no need for medical care. Although family reported that R1 complained of back and neck pain, there is no documentation showing visible injury or that R1 requested medical attention at that time. The text messages show that staff communicated with the family on the same day regarding the incident. Based on the information obtained, there is not enough evidence to prove that staff failed to seek timely medical attention for R1. Therefore, the allegation is unsubstantiated. {2 of 3} Allegation - staff did not provide proper wheelchair accommodations for resident, (R1). Interviews and record reviews were completed. During interview, staff stated that when R1 was admitted to the facility, R1 arrived with a large wheelchair that did not fit through the bathroom doors. Staff reported that the family asked if the bathroom doors could be removed to allow the wheelchair to fit. Staff stated they were unable to remove the doors because the bathroom is shared with other residents and removing the doors would violate the privacy rights of others in care. Staff stated that instead, they provided R1 with a smaller wheelchair as a loan until the family could provide an appropriate wheelchair. Staff reported that text messages between staff and the family confirmed this agreement. LPA reviewed text messages dated June 19, 2025 at 12:44 p.m. between staff members Patrick and Renae and R1’s family members. In the messages, on family stated that R1 fell backward in their wheelchair and that the wheelchair did not have an anti-tip feature. Family reported that R1 complained of back and neck pain. Patrick responded that the facility does not provide wheelchairs for residents and that the wheelchair being used was a loaner until R1 could obtain one through his primary physician or purchase one from a pharmacy. Patrick instructed the family on how to request a wheelchair through insurance. The text messages support that the facility provided a temporary wheelchair and informed the family that it was their responsibility to obtain a permanent wheelchair that met R1’s needs. There was no documentation reviewed showing that the facility refused to allow R1 to use an appropriate wheelchair if provided. The information gathered shows that the facility attempted to accommodate R1 by providing a smaller wheelchair when the original wheelchair did not fit through the bathroom door. The decision not to remove the bathroom doors was related to maintaining privacy for other residents. Based on interviews and records reviewed, there is not enough evidence to prove that staff failed to provide proper wheelchair accommodations. The facility provided a temporary wheelchair and communicated with the family regarding obtaining a suitable replacement. Therefore, the allegation is unsubstantiated at this time. A finding of unsubstantiated means that although the allegation may have happened the preponderance of evidence does not prove it. Exit interview was conducted and a copy of this report and appeal rights were provided via email. {3 of 3}the state’s words, verbatim · CDSS document, Mar 12, 2026 · control 27-AS-20250819084651

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Mar 13, 2026

The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interviews and record reviews, the licensee did not comply with the regulation cited. Facility did not ensure medications were consistently available and administered as prescribed. This poses an immediate heath, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Mar 12, 2026

Plan of correction: Facility is closed as of 9/24/2025.

Allegation investigated: Licensee did not adhere to proper eviciton protocols with residents in care.

On 03-12-2026, Licensing Program Analyst, Arvin Villanueva (LPA), conducted a collateral visit at Argonaut Care Home, Inc, located at 860 Argonaut Drive, Jackson, CA 95642, to deliver complaint findings regarding the allegations noted above. LPA spoke with Shadea James over the phone and stated the purpose of this visit. Note that this facility is closed as of September 24, 2025. Overview: A concern was raised regarding Argonaut Care Home involving potential illegal eviction and failure to properly secure residents’ belongings. Resident (R1) was refused readmission back to the facility after being hospitalized. R1’s family member returned to the facility and discovered some of R1’s belongings were missing. It was also discovered that all residents have been moved out. The family member reported that the facility had previously issued a 60-day notice, which was quickly replaced with a 30-day notice. Throughout this investigation, the Department conducted interviews, record reviews and facility observations. {1 of 2} Substantiated Allegation - Licensee did not adhere to proper eviction protocols with residents in care: The investigation into this allegation consisted of interviews and record reviews. On July 11, 2025, LPA Villanueva provided the licensees of Argonaut Care Home 2 the regulation Health and Safety Code (HSC) 1569.682, along with other information relating to their plan to forfeit their license. HSC 1569.682 – this section governs eviction and relocation procedures for the Residential Care Facilities for the Elderly (RCFE), which closely tied to Title 22 enforcement. The 60-day eviction notices issued by Argonaut Care Home 2 for two residents (R1 and R2) were reviewed. The notices do not meet the requirements of Health and Safety Code 1569.682. The notices were missing required items, including the resident’s service plan, a relocation evaluation with a list of facilities within 60 miles, a list of referral agencies, the right to contact the Department, Ombudsman contact information, and specific facts explaining the reason for the closure. Additionally, the Department did not receive the written eviction notices within the required five days of issuing the eviction notices to the residents. Based on the information gathered, this allegation was substantiated. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are cited on the 9099D during this visit. Exit interview conducted and a copy of this report and appeal rights were provided via email. {2 of 2}the state’s words, verbatim · CDSS document, Mar 12, 2026 · control 27-AS-20250910155206

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.682(a) · Plan of correction due date: Mar 19, 2026

A licensee of a licensed residential care facility for the elderly shall, prior to transferring a resident of the facility to another facility or to an independent living arrangement as a result of the forfeiture of a license, as described in subdivision (a), (b), or (f) of Section 1569.19,…take all reasonable steps to transfer affected residents safely and to minimize possible transfer trauma, and shall, at a minimum, do all of the following: This requirement is not met as evidenced by: Based on record reviews, the licensee did not comply with the regulation cited. The 60-day eviction notices that were provided to residents were incomplete. This poses a potential health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Mar 12, 2026

Plan of correction: This facility is closed as of 9/24/2025.

Allegation investigated: Staff did not prevent a resident from developing a stage 4 pressure injury while in care. Staff are serving cold meals to residents in care. Staff left a resident in a soiled diaper for a long period of time.

On 12/19/25, Licensing Program Analyst, Arvin Villanueva (LPA) conducted an in-person meeting with facility representative, Shadae James, to deliver complaint findings regarding the allegations noted above. Note that Argonaut Care Home 2 is closed as of 9/24/2025. This in-person meeting was held at Argonaut Care Home, Inc (facility #32701223). Throughout this investigation, LPA reviewed medical records, hospice notes, facility documents, and also interviewed staff and the administrator. Records showed that R1 was admitted to this facility on March 29, 2025, and already had several medical problems, including a history of skin breakdown. R1’s Physician’s Report stated that R1 was bedridden, unable to transfer on their own, and needed help with almost all daily tasks. R1 also used a Foley catheter and had a known history of skin issues. {1 of 3} Unsubstantiated R1’s Needs and Services Plan and Appraisal both showed that R1 needed help with bathing, dressing, toileting, and moving around, and that he sometimes became confused. Hospice records showed that nurses and home health aides visited R1 periodically and provided wound care, changes, catheter care, and hygiene support. The subpoenaed hospice documents confirmed that R1 already had pressure sores and other injuries before moving into the facility. The administrator (AD) stated that R1 came into the facility with the sores and that hospice was notified right away. AD also explained that R1 sometimes refused to be changed, and staff would encourage R1 when this happened. Staff interviewed denied leaving residents in soiled diapers and said they changed residents as needed. Based on all the information gathered and reviewed, the preponderance of evidence of standard is not met. Therefore, the allegation that the facility caused R1’s pressure injury or failed to prevent it was UNSUBSTANTIATED ************************************************************************ The investigation into the allegation that staff are serving cold meals to residents consisted of LPA reviewing screenshots of group text messages between the administrator and several staff members. The messages showed routine communication about daily tasks and short notes about residents, including a handwritten list of food items. However, the screenshots did not include any comments about food temperature, or any complaints from residents or staff about cold food. There were no time stamps, and no information showing how meals were prepared or served. Because of this, the screenshots did not provide evidence to support the allegation. The LPA also interviewed staff on duty (S1) on 6/4/25, which they stated that the facility does not serve cold meals unless the food is supposed to be cold, such as sandwiches. S1 explained that meals are served warm and that they have not seen staff give residents cold food. During an interview with Administrator Chukwudi Patrick Ikiseh (AD), stated that the facility does not serve cold meals unless the menu calls for a cold item. AD explained that staff often send him photos of the food they prepare, and he monitors meal quality through these messages. He said there have been no complaints from residents about cold food. Based on the information gathered, the preponderance of evidence is not met. Therefore, the allegation is UNSUBSTANTIATED. {2 of 3} The investigation into the allegation that staff left Resident 1 (R1) in a soiled diaper for a long period of time. Consisted of reviewing R1’s medical records, hospice notes, facility documents, and interviewed staff and the administrator. Records showed that R1 was admitted to facility on March 29, 2025, and had several medical conditions, including a history of skin breakdown. R1’s Physician’s Report stated that R1 was bedridden, unable to transfer on their own, and needed help with almost all daily care tasks, including toileting and hygiene. R1 also used a Foley catheter and sometimes became confused. R1’s Needs and Services Plan and Appraisal both showed that full assistance was required with bathing, dressing, toileting, and moving around the facility. Hospice records showed frequent visits from nurses and home health aides who provided bed baths, catheter care, wound care, and monitored R1’s hygiene. Hospice notes documented consistent care and did not report concerns about R1 being left in soiled conditions. Subpoenaed hospice documents also confirmed that R1 had injuries, including pressure sores, before moving into the facility, and that hospice continued to follow up on his care while he lived there. During an interview, Staff 1 (S1) stated they have not worked at the facility long but denied ever leaving residents in soiled diapers. S1 explained that residents are changed when needed. The administrator, Chukwudi Patrick Ikiseh, stated that R1 sometimes refused to be changed, and staff would encourage R1 when this happened. Based on the record review, hospice documentation, staff interviews, and the administrator’s statements, the preponderance of evidence is not met, therefore, the allegation is UNSUBSTANTIATED. Note that an unsubstantiated finding means that although the allegation may have happened the preponderance of evidence does not prove it. No deficiencies were cited as a result of this visit. An exit interview was conducted with Shadae James and a copy of this report and appeal rights were provided. {3 of 3}the state’s words, verbatim · CDSS document, Dec 19, 2025 · control 27-AS-20250602153344

Type of visit: Case Management - Other

On 9/19/2025, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced case management visit to return files to the facility that were removed on 9/18/2025 to be copied at the Regional Office. The facility is no longer operating and there are no residents and staff at the facility. LPA met with Facility Representative, Licreisha Wilson at another facility, down the street, that is owned by the same operators and stated the purpose of this visit. The facility supervisor, Renae Earl, was notified and stated she is unable to be at the facility at this time. Renae gave Licreisha permission to sign this report. LPA Villanueva handed the following files to Licreisha: resident binders belonging to R1 and R2. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 19, 2025

Type of visit: Case Management - Other

On 8/27/2025, at 9:30am, Licensing Program Analyst Arvin Villanueva (LPA) arrived at facility unannounced to conduct an inspection proceeding the closure of the facility. LPA met with Facility Supervisor Renae Earl (S1) and explained the purpose of the visit. A Notice of Facility Closure was received by the Regional Office with a noted facility closure date of 9/18/2025. LPA toured the facility with a staff Lacreisha Wilson (S2). LPA observed that there were no residents at the facility. LPA requested for Licensee to update the resident roster. LPA requested original License from the Licensee. LPA advised Licensee that the facility will be closed in the system as of 9/18/2025. Link to survey for Facility Closure provided to Licensee. www.surveymonkey.com/r/facilityclosure Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 27, 2025

Type of visit: Required - 1 Year

On 6/4/2025, at 9:50am Licensing Program Analyst Arvin Villanueva (LPA) arrived unannounced at this facility to conduct their required annual inspection visit. LPA initially met with the staff on duty Emmanuella Asamoah (S1) and stated the purpose of this visit. The Administrator Chukwudi (Patrick) Ikiseh was notified and arrived on at 11:50am. Also arrived is another staff Shadae Brown. Present during this visit were 3 residents in care with one staff on duty. Upon arrival, LPA observed 3 resident in the living room sitting on their reclining chairs watching TV. Two of the residents had family visits. 1 outside agency staff also visited one resident. LPA evaluated the physical plant with S1 to ensure the health and safety of the residents in care. The facility is a one-story home located in a residential neighborhood. Areas inspected are including but not limited to the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the inside of the facility to be clean at this time. LPA inspected 3 of 4 resident bedrooms and were observed to be equipped with the required furniture and sufficient lighting throughout the facility. in bedroom #2 on the facility sketch, LPA and S1 observed nail polish remover and accessible to resident in care. Per S1, resident's family sometimes bring in the item. S1 removed the nail polish remover and place it in locked area. LPA measured the hot water temperature in 1 resident bathroom located in the hallway and was at 128 degrees Fahrenheit. During the inspection of the bathroom, LPA and S1 observed a cleaning spray on the bathroom counter. S1 immediately removed the cleaning spray and locked it. Room temperature was observed at 77 degrees Fahrenheit. LPA observed sufficient seven day non-perishable and two day perishable food supplies. {1 of 3} Fire extinguisher located in the kitchen was observed and were last inspected on 6/18/2024. Smoke and carbon monoxide detectors were observed and found to be working during this visit. LPA observed centrally stored medications, toxins, and sharp objects were kept locked and inaccessible to residents in care. No bodies of water was observed at this time. Facility does not have a fireplace and bodies of water at this time. During an inspection of the garage with S1, LPA observed a bed equipped with beddings, beside table with perfume, deodorant, vasaline and other items on top of the table, an electric fan next to the bed, a sofa at the foot of the bed, and reclining chair. Also clothes on a table were observed. Per interview with S1, she is a live-in staff and confirmed she sleeps in the garage. Outdoor area was inspected. Facility has one exit gate. One of the gate is in need of repair as evidenced by the door is dragging at the bottom. Debris and old furniture were observed at the right side of the house. Per discussion with Administrator, they plan to discard these items. Also during the outdoor inspection, LPA observed the two sheds were unlocked. LPA observed inside 1 of 2 sheds to contain gardening tools, jars containing screws, old wheelchairs, old walkers, and other miscellaneous items; these were accessible to residents in care. Also, observed inside 1 of 2 sheds were vermin droppings on a shelf. However, LPA did not observed any evidence of vermin droppings inside the facility during this visit. Advisory was provided to address the presence of vermin and that can potentially affect the inside of the facility. Also during the outdoor inspection, LPA observed 2 pain cans at the side of the house. Administrator discarded the 2 paint cans. Review of 4 resident files (R1, R2, R3 R4) include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. Advisory was provided to ensure each resident have PRN authorization letter signed by their physician on file. Review of 3 staff files (S1, S2, and S3) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. Administrator Certificate is current. Through review of Guardian and LIS, S1 is not associated to this facility. Through staff record review, S1 has her fingerprint from Department of Justice (DOJ) on file. During this visit, Administrator removed S1 from the facility until S1 is officially associate to this facility. Later during the visit, S1 was able to be associated to this facility. {2 of 3} Facility conducts quarterly disaster drill. Facility has a dementia and infection control plan. Administrator to submit current Liability Insurance Certificate, LIC500 and LIC308 to the Department. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were observed during today's visit. Exit interview was conducted and a copy of the report and appeal rights were provided upon exit.the state’s words, verbatim · CDSS document, Jun 4, 2025

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 6/13/24 at 10:00am. LPA observed the Administrator Certificate expires on 10/06/2024 for Chukwudi Ikiseh. LPA met with Marie Longmore, and Sophia Brown, Caregiver(s) and stated the purpose of todays visit. LPA spoke with Administrator Chukwudi Ikiseh regarding todays visit. Shadae James, Designee arrived within 15 minutes to assist with todays visit. The most recent emergency drill was conducted on 5/14/24. The facility is licensed for a capacity of 6 residents of which 1 may be bedridden in room 1. Hospice waiver approved for 2 to receive hospice care services. There is 2 residents receiving hospice care services during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 76*F which is within the required range of 68-85*F. The hot water temperature was measured at 111.6*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA reviewed 2 staff and 2 resident files and conducted interviews during this visit. Upon a file review the following items were discussed to be submitted with any changes annually: Licensing fees-Current Criminal Record Clearances LIS536-Current Administrative Organization LIC309-Current Designation of Administrative Responsibility LIC308-Submit Personnel Report LIC500-Submit Affidavit Regarding Client/Resident Cash Resources LIC400-NA Surety Bond LIC402-NA Facility Floor Plan/Plot Plan LIC999-Current Fire Clearance (consistent with terms and limitations of license)-NA Qualifications of Administrator/Facility Manager-Submit Articles of Incorporation/Organization, Constitution and bylaws-NA Partnership Agreement-NA Control of Property-Submit Emergency Disaster Plan LIC610D-Submit Plan of Operation (Restricted Health Care Plan)-NA Admission Policies and Procedures-NA Health Screening Report-Facility Personnel LIC503-NA Bacteriological Analysis of Private Water Supply-NA In-service Training Program-NA Medication Procedures-NA Transportation Procedures-NA Job Description/Personnel Policies-NA Exemptions/Waivers and Exceptions-Current First aid/CPR certificates-Current Liability Insurance-Submit (if Applicable) Infection Control Plan-Submit Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. Exit interview held. A copy of todays’ report provided.the state’s words, verbatim · CDSS document, Jun 13, 2024

Type of visit: POC

On 3/6/24 at 1pm, Licensing Program Analysts (LPA) Arvin Villanueva arrived at the facility to conduct an unannounced Plan of Correction (POC) visit. LPA initially met with the staff on duty and explained the purpose of the visit. The facility administrator, Chukwudi Ikiseh, was notified of the visit via telephone. LPA spoke to the administrator via telephone and explained the purpose of the visit. The purpose of this visit was to verify the plan of correction that was required to be completed on 11/28/23 and 12/4/23 for deficiencies that were previously cited on a prior visit conducted on 11/27/2023. Present during this visit are 4 residents in care with 1 staff on duty. Upon arrival to the facility, LPA observed a medicine cup filled with medication pills. On the cup, a resident's name is on it. Per interview with staff on duty, the resident is currently sleeping and not ready to take the medication pills. Staff on duty put away the medication. During staff file review, LPA observed 2 of 3 staff have expired first aid certificate. Additionally, files for the above administrator, Chukwudi Ikiseh is not available for review during this visit. Based upon this inspection, LPA Villanueva observed the following: The deficiency cited under Title 22 Regulation 87465(e) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. The deficiency cited under Title 22 Regulation 87412(a)(11) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. The deficiency cited under Title 22 Regulation 87412(f) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. The deficiency cited under Title 22 Regulation 87412(a) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. LPA observed during today's POC visit that the administrator's file is not present at this facility and not available for review at this time. Con't to LIC809-C... The deficiency cited under Title 22 Regulation 87406(a)(1)(A) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. LPA observed during today's POC visit that the administrator's file is not present at this facility and not available for review at this time. The deficiency cited under Title 22 Regulation 87412(d) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. LPA observed during today's POC visit that the administrator's file is not present at this facility and not available for review at this time. The deficiency cited under Health and Safety Code 1569.267(d) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. The deficiency cited under Health and Safety Code 1569.695(c) has been cleared. Licensee complied with the terms of the POC by POC due date. POC was corrected during the post-licensing visit on 11/27/23 by providing LPA documentation of fire drill conducted on 10/29/23. A POC letter was generated and provided to the licensee. During today's visit, LPA reviewed facility documentation for fire/emergency drill. From the document review, LPA did not find subsequent quarterly fire/emergency drills. The deficiency cited under Title 22 Regulation 87633(b)(6) has not been cleared. Licensee did not comply with the terms of the POC by POC due date. LPA only received training completion of one staff for this citation. There were no other hospice training documentation to review during today's visit. The deficiency cited under Title 22 Regulation 87633(b)(6)(A) has not been cleared. Licensee did not comply with the terms of the POC by POC due date. LPA only received training completion of one staff for this citation. There were no other hospice training documentation to review during today's visit. Immediate civil penalties are being assessed due to repeat violations. The facility was informed that the civil penalty will continue to accrue $100 per day per violation until the deficiency is corrected. As a result of this case management, the facility is not in compliance with Title 22 Regulation, and the deficiencies can be found on the LIC 809 D page. An exit interview was conducted, and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.the state’s words, verbatim · CDSS document, Mar 6, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Mar 6, 2024

(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the above regulation as LPA observed resident medicatiosn dispensed in a medicine cup, placed on top of the dining table during the visit (photo was taken). This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 6, 2024

Plan of correction: Licensee to provide training to staff regarding medication administration. Date of staff training to be submitted to the Department by POC due date. Proof of training to be submitted to the Department once training is completed.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.695(c) · Plan of correction due date: Mar 13, 2024

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Based on facility record review, the licensee did not comply with the section cited above as there is no evidence of fire drill was done after 10/29/23, which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 6, 2024

Plan of correction: Licensee to submit proof of current quarterly fire drills to the Department by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(b)(6) · Plan of correction due date: Mar 13, 2024

(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: (6) Identification of the training needed, which staff members need this training, and who will provide the training relating to the licensee's responsibilities for implementation of the hospice care plan. This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above as there is no evidence of hospice training available for review during this visit which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 6, 2024

Plan of correction: Licensee will ensure all staff receive hospice care training that meets requirements. Licensee will submit evidence of staff training to the department by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(c)(1) · Plan of correction due date: Mar 13, 2024

(c) All RCFE staff who assist residents with personal activities of daily living... (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Based on record review and staff interview, licensee did not comply with the section cited above in 87411(c)(1). Based on on bservation, 2 of 3 staff files reviewed do not have current first aid training which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 6, 2024

Plan of correction: Licensee to ensure 2 of 3 staff will complete First Aid Training and submit to CCLD by POC date.

Type of visit: Post Licensing

On 11/27/23 at 9:30am, Licensing Program Analysts (LPA) Christina Valerio and LPA Arvin Villanueva arrived to the facility unannounced to conduct a post-licensing inspection. LPAs initially met with staff on duty and explained the purpose of the visit. Administrator Chukwidi "Patrick" Ikiseh arrived shortly after. During this visit, there are two (2) staff on duty with three (3) residents in care. Facility is COVID-free status. At 10:00am LPAs inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, living area, other common areas, and outside of the facility to ensure compliance with Title 22 regulations. Facility is a single-story home with a fire clearance to serve 6 non-ambulatory elderly residents with approved 1 bedridden resident in bedroom #1. Facility also has a waiver for 2 hospice residents and has been licensed to retain residents with dementia. Facility has 4 resident bedrooms, and 2 bathrooms for resident use. LPA observed both bathrooms to contain grab bars, non-skid flooring, shower chairs, close lid trash containers and hygiene supplies. Resident bedrooms were sanitary, furnished, well-lit and had adequate storage for resident’s belongings. The facility common areas are cleaned and furnished. Facility has a dining area off the kitchen and a formal living room. In the kitchen area, LPAs observed to be sanitary and free of clutter. Additionally, the kitchen knives and other sharp objects are kept in a locked drawer. Toxins and cleaning supplies are kept locked and inaccessible to residents in care. LPAs observed the facility to have adequate food supply with at least 2 days’ worth of perishables and 7 days’ worth of non-perishables. LPAs observed functioning washer and dryer on the way to the garage. In the garage, LPAs observed an additional fridge and couches/futons. Water temperature reads 105*F to 120*F in 1 of 2 bathrooms; and room temperature reads 76*F. Smoke and carbon detectors were in good repair. Fire extinguisher was serviced on 15/19/23. Medication storage area was observed to be locked and inaccessible to residents in care. Medication records for 1 of 3 residents were reviewed and observed to be not in compliance with regulation. First aid kit was observed to have adequate supplies and accessible to staff. {Con't to LIC 809-C} {Con't from LIC809} During this inspection, 3 resident files and 2 staffing files were reviewed for regulatory compliance. 2 of 3 resident files were observed to be not in compliance with regulations. LPAs also observed 1 of 2 staffing files to be not in compliance with regulations. Review of staffing timesheet binder reveals no evidence of night supervision. Additionally, administrator's files were not available for review during this visitl. LPAs completed 1 staff interview and attempted resident interviews. LPAs record review revealed no evidence of quarterly fire drills available for review. LPAs also conducted the inspection using the CARE tool. The facility has an approved infection control plan in place. LPAs requested an updated copy of Liability Insurance, LIC 308 and LIC 500. Per California Code of Regulations, Title 22 and Health and Safety Codes, deficiencies were observed during this visit. Interview was held with the Chukwudi Ikiseh and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Nov 27, 2023

The state marks this report as 13 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.