Beatrice Home Care

Type of visit: Case Management - Deficiencies

On 08/18/26, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to conduct a case management visit as a follow-up to the annual inspection. LPA identified herself upon arrival, stated the purpose of the visit and asked to meet with the Facility Administrator. The Administrator was not present. LPA met with the Designee, Cece Timberlic. During the annual inspection on 08/12/26 2 deficiencies were cited that required civil penalties to be assessed: a background clearance violation and a fire clearance violation. Civil penalties were assessed for those deficiencies and delivered today, $1,000.00 for the fire clearance and $500.00 for the background clearance. A copy of this report was provided along with APPEAL RIGHTS and an exit interview was conducted with Cece Timberlic.the state’s words, verbatim · CDSS document, Aug 18, 2026

Type of visit: Required - 1 Year

Unannounced Annual Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility on 08/12/26. LPA identified herself to the Caregiver on duty, explained the purpose of the visit, and asked to speak with Licensee/Administrator. Staff called the Administrator, Beatrice Clark, who told this LPA that she would arrive in approximately 20 minutes. LPA was met by a worker who was left alone with a resident unsupervised. This individual was not background cleared. This deficiency was cited on the LIC 809D page. The inspection began in the kitchen. All knives and sharps were locked and inaccessible to residents in care. The food supply was adequate for 2-day perishable and 7-day nonperishable. There were two opened jars of peanut butter and an open bottle of BBQ sauce in the refrigerator. LPA pulled a sample of 5 refrigerated items and 5 pantry items and checked for expiration dates. None were expired, but this LPA observed an open bag of rice and an open bag of flour. LPA also observed a jar of sugar with ants in the cabinet. Deficiencies for food storage and pests were cited on the LIC 809 D page This facility was licensed for 6 residents, 5 of whom may be non-ambulatory. Bedrooms 1,2,3 and the master approved for non-ambulatory. Bedroom 4 approved for ambulatory only. Hospice waiver for 2. LPA inspected the 4 resident bedrooms, 2 bathrooms, and all common areas as well as the garage. LPA noted soap, paper towels and trash cans with lids in bathrooms. The hot water temperature was measured at 103.6 degrees Fahrenheit and was not in compliance. The 2 fire extinguishers were last serviced on 03/11/26 by Jorgensen Co. and was also in compliance. The exterior of the building was inspected by the LPA. There were no bodies of water present and the yard was completely fenced in. LPA observed the screen on the master bedroom sliders was missing and a shaded area with chairs for residents to enjoy. During today's walkthrough, LPA observed a drawer in the kitchen missing its handle as well as handles missing of drawers in residents rooms. The cabinet under the sink was also missing its handle and the light switch in the bathroom was broken. These deficiencies were cited on the LIC 809D page. The LPA observed the medication cabinet was left open and accessible to residents. This deficiency was cited on the LIC 809D page. A review of the First Aid kit by the LPA found it to be complete and in compliance. LPA reviewed a resident file and found that the last LIC 602 was dated 2023. This resident had a change of condition and a new one was overdue. This deficiency was cited on the LIC 809D page A review of the file for the caregiver on duty was also completed. Their file was missing a health clearance and proof of CPR / First Aid certification. The Administrator did not have a copy of her file at the facility for me to review. That deficiency was cited as well. According to the California Code of Regulations, Title 22, all deficiencies were cited on the LIC 809 D page, however due to time constraints, this LPA will have to return at a later date to assess civil penalties. A copy of this report was provided along with APPEAL RIGHTS and an exit interview was conducted with Clark.the state’s words, verbatim · CDSS document, Aug 12, 2026

The state marks this report as 15 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Jason Lund arrived at the facility unannounced to do a case management visit. LPA Lund met with staff and later with Administrator Beatrice Clark. During LPA Lund visit LPA Lund spoke with all residents in care. During the interview process LPA Lund spoke with Resident (R1) who stated that R1 didn’t want to get out of the bed. LPA Lund did not observe a Hoyer lift or a wheelchair to help him R1 get out of bed. LPA Lund issued citations and civil penalties during todays visit which are attached. Exit interview and copy report, appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jul 29, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Jul 30, 2026

87202(a) Fire Clearance-All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance...This requirement is not met as evidenced by: Based on observation, and interview with R1. the licensee failed to obtain an appropriate fire clearance. LPA observed that R1 is bedridden. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 29, 2026

Plan of correction: Administrator will find proper placement.

Type of visit: Case Management - Deficiencies

On 04/13/26 Licensing Program Analyst (LPA), Kimberly Viarella, made an unannounced visit to this facility to conduct a case management visit following a complaint investigation earlier in the day. LPA identified herself upon arrival, stated the purpose of the visit and met with the Designated Facility Administrator Beatrice Clark to cite for the deficiencies observed during the earlier visit. LPA met with employee, S1 who was not associated to this facility. The Administrator confirmed that this deficiency was cited on the LIC 809D page. A Civil Penalties was also assessed in the amount of $500.00 A copy of this report along with APPEAL RIGHTS was also provided and an exit interview was conducted with Clark.the state’s words, verbatim · CDSS document, Apr 13, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(c) · Plan of correction due date: Apr 14, 2026

(c) A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another... by providing the following documents to the Department: The Licensee did not ensure this requirement was met as evidenced by: Based on interview and observation, S1 was not associated to this facility. This posed an immediate threat to the health, safety and personal rights of resdients in care.the state’s words, verbatim · CDSS document, Apr 13, 2026

Plan of correction: The LIcensee/Administrator obtained the PER ID and stated they would send a copy of the online tranfer requests to this L.PA by the close of buisness on 4/14/26

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Christina Valerio was at the facility for a subsequent visit (27-AS-20260102121523). During the visit, LPA Valerio observed two staff on shift. One of the two staff did not have fingerprint clearance. Administrator Beatrice admitted that Staff 1 (S1) does not fingerprint clearance and had been working since last Thursday. Administrator Beatrice stated she was supposed to take S1 but had an emergency. S1 is new and had been working a few days. S1's shifts is evening from 6:00 PM until 6:00 AM. Administrator Beatrice stated that moving forward Staff 2 will be on shift from 6:00 AM - 6:00 PM and Staff 3 will be on shift from 6:00 PM - 6:00 AM until S1 is cleared to work in the facility. Administrator Beatrice was informed of today's citation and the assessment of a civil penalty in the amount of $500. LPA Valerio observed S1 leaving the facility with S3. Per California Code of Regulations (CCR) - Title 22 - deficiencies are being cited today due to an immediate health and safety risk to residents in care. Appeal rights were provided. An exit interview was held with staff Shawnta Martin, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 9, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(g)(1) · Plan of correction due date: Jan 10, 2026

87411Personnel Requirements - General (g) Prior to employment or initial presence in the facility, all employees and... shall: (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations..This requirement was not met as evidenced by: Based on observations, interview, and record review, the licensee did not ensure staff obtained a fingerprint clearance prior to working in the facility, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 9, 2026

Plan of correction: Licensee stated that S3 will pick up S1 to get fingerprints completed. Licensee stated S3 will be working S1's shifts until S1 is cleared to work in the facility. LPA Valerio to recieve a statement from licensee stating acknowledgement of 87411 and proof of S3 working S1's shifts by POC due date.

Type of visit: Case Management - Annual Continuation

On 7/24/2025, Licensing Program Analysts Kimberly Viarella and Arvin Villanueva (LPAs) conducted an unannounced Case Management annual continuation visit at the facility to continue with the Annual visit initiated on 7/16/2025. LPAs met with staff on duty, Etta Mae Shaw and stated the purpose of the visit. The Administrator Beatrice Clark was notified of the visit. During this visit, LPAs conducted facility observations. In bedroom #3 from the facility sketch, LPAs found medication labeled Albuterol Sulfate inside the closet. LPAs also observed hygiene supplies inside resident drawers. The fire door leading to resident bedrooms was observed to be propped open with a shoe/sandal. This was also observed during the initial visit on 7/16/25. In bedroom #1 from the facility sketch, LPAs observed resident bed to be blocking the resident drawer, making it difficult to access resident belonging stored inside the drawer. In bedroom #2 from the facility sketch, LPAs observed resident do not have a bed but is using a reclining chair. Per discussion with resident from the initial visit on 7/16/25, resident does not use a bed. Per discussion with Beatrice, it is a personal choice of the resident. Also, this room does not have a closet door. Per discussion with Beatrice, resident do not want to have a door for easy access to their belongings. LPA Villanueva confirmed this with the resident. In bedroom #4 from the facility sketch, LPAs observed the presence of ants on the floor near the resident dresser. The ants were also observed from the initial visit on 7/16/25. LPAs also observed a walker inside the closet. Per interview and record review, the resident residing in this bedroom is considered non-ambulatory as evidence by the presence of walker and resident is using wheelchair during the visit. {Con't to 809-C} In the master bedroom, two residents share this room. This room has a master bath. The exit door was difficult to unlock. The latch was broken. In the master bath, LPAs observed the shower not equipped with grab bars and did not have a shower curtain. Inside the master bath, there is a closet where it stores two Hoyer Lifts. The door to the garage was observed to be locked. Per review of the facility’s current Emergency and Disaster Plan, the door to the garage is not considered an exit anymore, and is currently inaccessible to residents. During the initial visit on 7/16/25, LPAs inspected the garage. Inside the garage, LPAs observed 2 beds and a dresser. LPAs observed the following, but not limited to, clothes, boxes, barrels, wheelchairs, chemicals, cleaning supplies, laundry detergents, and old furniture. The hallway bathroom was inspected. The light switch was observed to be in disrepair. The sink cabinet did not have handles. During the initial visit on 7/16/25, LPAs observed a pair of scissors in the sink cabinet. LPAs did not observe shower curtains. Inside the medicine cabinet, LPAs observed hygiene supplies belonging to staff. Inspection of the kitchen, LPAs observed food items in the pantry and refrigerator/freezer that were open but were not dated accordingly. One dining chair in the kitchen area was observed to be in disrepair. One of the leg was not secured. On 7/16/24, LPA Villanueva reviewed 4 of 5 resident medications. The review included a review of resident’s most current medication list and comparing it to what medication is available at the facility. Per medication review, 3 residents had some medications that were not available at the facility for review. Per medication review, 1 resident had an expired medication. Per medication review, 1 resident did not have discontinued medication order from their physician. Staff record review: LPAs reviewed 3 staff files. It was determined that all 3 staff obtained their First Aid/CPR certificate from an online only service called the National CPR Foundation and is not an approved trainer for the Department of Social Services since it does not meet the regulation requirements Interviews: LPAs spoke with 3 residents in care in their bedroom and one staff on duty. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were observed during this annual inspection. Note that additional deficiencies will be cited in a case management 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, Jul 24, 2025

The state marks this report as 23 pages; the online copy we transcribed has 12. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 7/17/2025 at 4:54pm, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced case management visit for the purpose of returning resident files that were removed on 7/16/2025. The files removed were copied at the Regional Office. LPA was met by staff on duty Etta Mae Shaw and stated the purpose of this visit. Administrator Beatrice Clark was notified and gave permission for Etta to sign this report. Present during today's visit were 6 residents in care with 1 staff on duty. LPA Villanueva returned the following files to staff on duty: 6 resident binders (R1 - R6). Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 17, 2025

Type of visit: Required - 1 Year

On 7/16/2025, Licensing Program Analysts, Kimberly Viarella and Arvin Villanueva (LPAs) arrived unannounced at this facility to conduct their annual inspection visit. LPAs initially met with staff on duty (S2) and stated the purpose of the visit. The Administrator Beatrice Clark (S1) was notified and arrived later. Overview: Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 elderly residents. 5 may be non-ambulatory. Bedrooms 1, 2, 3 and Master bedroom approved for non-ambulatory. Bedroom 4 approved for ambulatory only. Facility has hospice waiver for 2 residents. Initial Observation: Upon arrival, LPAs observed 3 residents having their morning meal at the dinning table. Present during this visit were 6 residents in care with 1 staff on duty (S2). There was an outside agency staff assisting one resident. The room temperature was at 72 degrees Fahrenheit. Physical Inspection and Operational: Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA inspected 5 resident bedrooms. Master bedroom is occupied by 2 residents. Bedroom #4 is currently being occupied by a non-ambulatory resident. LPA measured the hot water temperature in the 1 of 2 bathrooms to be at 107 degrees Fahrenheit. The light switch in the hallway bathroom was observed to be in disrepair. Also inside the hallway bathroom, LPAs found scissors under the sink cabinet, unlocked and accessible to residents in care. The bathroom inside the master bedroom, LPAs found a disinfectant spray inside the sink cabinet that was unlocked and accessible to residents. Also inside the bathroom in the master bedroom, LPAs observed the shower area to not equipped with grab bars. The master bedroom bath also has a closet which contains 2 Hoyer lifts. {Con't to 809-C} {Con't from 809} Fire extinguisher was observed in the kitchen area and hallway and was last inspected on 4/15/2024. Smoke and carbon monoxide detectors were observed throughout, tested and found operable during this visit. Fire door leading to the resident bedrooms were observed to be propped open with a sandal. In the kitchen area, LPA observed sufficient seven day non-perishable and two day perishable food supplies. Pantry was observed to be stocked with non-perishable food items. Kitchen refrigerator and freezer were maintained at regulatory temperature. Inside the kitchen refrigerator, LPAs found resident medication that was accessible to residents in care. Per interview with S1, staff lock the refrigerator. During this visit, S1 purchased a lock box for the medication. Outdoor area was inspected. LPA observed outdoor furniture for resident use. Ramps were observed to be in good repair at this time. Emergency walkways were observed to be unobstructed. Fence and gates were in good repair at this time. Record Reviews: Review of 6 of 6 resident files (R1 - R6) was conducted, include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. LPAs noted some issues. Medication review of 4 of 6 residents include review of physician orders for over-the-counter medications. LPAs noted some issues. Per S1, they do not have Centrally Stored Medication Record available for review during this visit. Review of 2 staff files (S1 and S2) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. S2 did not have a current first aid certificate on file available for review during this visit. Fire drill/disaster drill records were not available for review during this visit. Infection Control Plan and Emergency Procedure Plan were not available for review during this visit. First Aid kit was reviewed and found to be incomplete at this time: needs bandages and first aid manual. LPA was provided a copy of current Liability Insurance Certificate, LIC500 and LIC308 during this visit. Interviews: LPA interviewed 2 staff and 2 residents during this visit. Based on today's visit, this annual needs continuation. Exit interview was conducted with S1. A copy of the report was provided upon exit.the state’s words, verbatim · CDSS document, Jul 16, 2025

The state marks this report as 26 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Office

A virtual informal conference - office meeting was held via Microsoft Teams to discuss Beatrice Home Care. Present in today's meeting was Licensing Program Analyst (LPA) Christina Valerio, Licensing Program Manager (LPM) Stephen Richardson, and Facility Representative, Licensee Beatrice Clark. The following topics were discussed during the informal conference: Personnel Requirements Care of Persons with Dementia Building and Grounds Maintenance and Operation Personal Rights of Residents in All Facilities Staff training Activities The facility will do the following to achieve compliance: Continue to maintain cleanliness of facility Continue to maintain upkeep of building and grounds Update monthly calendar for activities offered and completed Continue to train staff and document in-service training Continue to monitor and document water temperatures Continues LIC 809 - C... Continued from LIC 809 The facility will do the following to achieve compliance: Continue to ensure cleaning supplies are locked an inaccessible to residents in care Continue to ensure staff are fingerprinted and associated to the facility prior to providing direct care Continue to maintain resident and staff files and have it readily available at the facility Continue to collaborate and update Regional Office as needed The regional office will do the following: Continue to collaborate and provide assistance to licensee as needed LPM Richardson discussed the option for the Technical Support Program (TSP) and informed licensee to inform the Regional office if they would be interested in participating. At this time, the licensee did not want to participate, LPA Valerio sent a copy of the TSP handout should the licensee change her mind. Per California Code of Regulations (CCR) - Title 22 - no deficiencies are being cited. An exit interview was held, and a copy of the report was sent via email. Licensee to send a signed copy to LPA Valerio.the state’s words, verbatim · CDSS document, Jan 15, 2025

Allegation investigated: Staff did not receive all required training(s). Staff do not provide appropriate supervision to residents in care.

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint investigation findings. LPA Valerio met with facility staff Etta Mae, and explained the purpose of the visit. The following has been determined as it relates to the aforementioned allegations. The investigation consisted of review of facility files, LPA observation, resident interviews, and staff interviews. Staff did not receive all required training(s). LPA Valerio reviewed staff training submitted by Administrator Beatrice. Administrator submitted training files for facility staff 1 (S1) and staff 2 (S2) . LPA Valerio reviewed the facility roster. LPA did not observe Staff 2 (2) on the associated list for Beatrice Home care. Continues on LIC 9099 - C... Substantiated Continued from LIC 9099 LPA Valerio reviewed facility files for Staff 1 (S1). LPA observed completed training certificates for the following topics: Medication training - 01/10/2024, Dementia Care Staff Training - 02/02/2024, Osha training - 01/20/2024, 40 hour orientation training - completed, Oxygen training - 02/01/24, Orientation training - 01/18/24 - 02/01/2024, and Disaster and Emergency Training - 02/01/2024. All training were instructed by Administrator Beatrice. On 11/26/2024, LPA Valerio observed Staff 3 (S3) working at the facility. Licensee/Administrator Beatrice was cited for California Code of Regulations (CCR) Title 22, Section 87411(g)(2) for not obtaining a fingerprint clearance for S3 prior to working at the facility. According to an interview with S3, S3 was there shadowing the main staff, S1. LPA Valerio learned during this visit that S3 was assisting residents over the weekend. When S3 was questioned, S3 stated the residents are going to get S3 in trouble. Administrator Beatrice confirmed during this visit that paper work and training was still in the process for S3. S3 did not have any prior training or experience. Therefore, the allegation of Staff did not receive all required training is substantiated. Staff do not provide appropriate supervision to residents in care. On 10/24/2024, LPA Villanueva observed the facility to be in disrepair in Resident 1's (R1) room. On 11/05/2024, the facility was cited for the allegation facility is in disrepair. On 11/05/2024, LPA Valerio observed R1's bedroom. LPA observed the holes next to the electrical socket to be repaired; however, the electrical socket was missing a cover. LPA observed the scratches on the window frame and bed frame still is disrepair. LPA Valerio interviewed staff regarding the R1's behaviors. According to the Administrator, R1 has had these behaviors but nothing has worked. They will fix the facility and R1 will go and do it again. LPA Valerio interviewed S1. S1 stated they try to give one hand activity to R1, but R1 will try to eat it. The amount of damage done, such as digging into the window seal and walls, show that the facility is not supervising R1 or attempting to redirect resident. During LPA's visits, S1 has been on shift without assistance to provide care and supervision to up to 6 residents while conducting daily activities. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8) are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided. An exit interview was conducted, and a copy of the report was left at the facility. Continued from LIC 9099 - A LPA Valerio reviewed resident records for Resident 1 (R1) - Resident 5 (R5). R1, R2, and R3 did not have injections listed on their medication list. R4 was observed to have tablets for medication. However, on a medication list from a previous rehabilitation center, there are 3 injections on the list. It says started date 06/18/2024 with no end date. There is a hand written note saying discontinue, but it is unclear if this was discontinued. On the LIC 602, there is an N/A next to able to administer own injections and yes to able to perform own glucose testing. On 12/20/2024, LPA Valerio went to observe R4's medication but learned R4 moved out of the facility. Administrator Beatrice did not provide a complete copy of R5's file and therefore, LPA was unable to determine if injections are provided. On 12/20/2024, LPA Valerio reviewed R5's medications. LPA did not observe injections present at the facility for R5. Administrator does not spend sufficient number of hours at the facility. On 10/24/2024, 11/05/2024, 11/26/2024, and 12/20/2024, LPAs observed Staff 1 (S1) on shift. LPAs did not observe Administrator Beatrice present when LPAs arrived at the facility. During each visit, Administrator Beatrice went to the facility after learning of arrival of the LPA. According to an interview with OA, anytime OA visits the facility, Administrator Beatrice is never there. According to an interview with Administrator Beatrice, Administrator stated she is always here. She comes when it is necessary. For example, she will come in the morning, she will coming in the evening, or she will come to work the over night shift. Administrator Beatrice stated she travels from her facility in Elk Grove and her facility in Galt. Based on all the information collected by the Department, although the allegation may have happened or is valid, here is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview was held and a copy of report was left at the facility.the state’s words, verbatim · CDSS document, Dec 20, 2024 · control 27-AS-20241017164426

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(c) · Plan of correction due date: Jan 20, 2025

87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training.... This requirement was not met as evidenced by: Based on observations, the licensee did not ensure Staff 3 had required training prior to working with residents in care, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 20, 2024

Plan of correction: Licensee to send completed training for Staff 3 by POC due date

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jan 20, 2025

87468.2... (a)... residents...shall have all of the following personal rights:(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Based on observation, records review, and interviews, the licensee did not ensure to provide care and supervision to R1 to ensure R1 did not engage in potential harmful behaviors.the state’s words, verbatim · CDSS document, Dec 20, 2024

Plan of correction: Licensee to send LPA a detailed plan of how the facility will increase staff care and supervision to ensure all resident's needs are met. LPA to receive plan by POC due date.

Allegation investigated: Facility staff are sleeping in garage without having an approved fire clearance

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint investigation findings. LPA Valerio met with facility staff Etta and another staff member, and explained the purpose of the visit. LPA Valerio contacted Administrator Beatrice via cell phone. LPA Valerio conducted unannounced visits. On 08/29/24, LPA observed the furniture removed from a resident room and placed in the garage. According to staff interviews, the beds were from the previous resident that were in process. 3 out of 3 staff interviews denied any staff living in the garage. On 11/05/24, LPA Valerio observed the same furniture in the garage. The beds were observed to be dismantled and had folded extra linens on top. During 11/26/24's visit, the beds were in the same condition. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, nothe state’s words, verbatim · CDSS document, Nov 26, 2024 · control 27-AS-20240820160250

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced on a subsequent visit. LPA Valerio met with two (2) facility staff members, and explained the purpose of the visit. LPA Valerio observed the facility's regular day time staff, Etta Mae. LPA observed a new staff member. LPA Valerio took her name down and did not observed the resident on the associated staff roster. According to Administrator Beatrice, the new staff member is not working but will soon be working after she is associated. Beatrice stated the staff went to get their fingerprints but they are waiting for the approval letter. Beatrice stated a previous LPA informed her staff can be present as long as they are not working with residents. Administrator Beatrice stated the staff was present for only two days and doing one to two hours of training. LPA Valerio observed interactions and conversations with residents and staff. According to Resident 1 (R1), the new staff member has been helping R1 get better so that R1 can get out of here. R1 hugged the new staff member. According to a conversation with a family member of a resident and staff, staff informed the family member that they assisted Resident 2 (R2) with doing exercises yesterday. Based on records review, observations, and interviews, the licensee allowed a facility staff to work in the facility without obtaining a cleared fingerprint clearance. The licensee was made aware an immediate penalty of $100 per cited violation per day for a maximum of five (5) days shall be assessed. The licensee was made aware a civil penalty in the amount of $200.00 will be assessed on today's date due to the staff member being at the facility for two days. An exit interview was held, and a copy of the report was provided. Appeal rights were provided. Failure to correct deficiencies may result in additional civil penalties.the state’s words, verbatim · CDSS document, Nov 26, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(g)(2) · Plan of correction due date: Nov 27, 2024

87411 Personnel Requirements - General (g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (2) Request a transfer of a criminal record clearance... This requirement was not met as evidenced by: Based on observations, records review, and interviews, the licensee did not ensure 1 out of 2 staff present in the facility were fingerprinted and cleared. This poses an immediate health, safety, and personal rights risk to residents.the state’s words, verbatim · CDSS document, Nov 26, 2024

Plan of correction: Licensee stated the administrator will take the staff member to get a fingerprint clearance today, 11/26/24. Licensee to send LPA Valerio proof by POC due date of 11/27/24.

Allegation investigated: Licensee creates hostile environment by yelling at staff in front of residents

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint investigation findings. LPA Valerio met with facility staff Etta, and explained the purpose of the visit. LPA Valerio was later met by Administrator Beatrice. The following has been determined as it relates to the above mentioned allegations. The investigation consisted of interviews with staff, interviews with residents, and LPA observation. According to the Reporting Party (RP), the RP overheard yelling inside the facility. The RP reported speaking to a staff member, Staff 4 (S4), which stated the Licensee Beatrice was yelling at S4. RP did not personally observe the licensee yelling. Continues on LIC 9099 - C... Unsubstantiated According to an interview with Staff 1 (S1), S1 has not observed the licensee yell at anyone nor at S1. S1 stated staff do not yell. According to an interview with Staff 3 (S3), S3 reported never yelling at anyone and has not observed anyone yelling at staff or residents. LPA Valerio was unable to interview S4 and does not currently work at the facility. According to an interview with Resident 1 (R1), R1 "thinks staff are fine." R1 did not know the names of any of the staff. According to an interview with Resident 2 (R2), R2 reported staff not yelling and has not heard any staff yelling at residents. The other residents in the home were not able to participate in the interview process due to communication barriers. Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview was held and a copy of report was left at the facility.the state’s words, verbatim · CDSS document, Nov 5, 2024 · control 27-AS-20240820160250

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Facility is in disrepair.

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint investigation findings. LPA Valerio met with facility staff Etta, and explained the purpose of the visit. LPA Valerio was later met by Administrator Beatrice. The following has been determined as it relates to the above mentioned allegations. The investigation consisted of LPA observations and an interview with an outside agency. On 10/24/2024, LPA Villanueva observed 4 of 5 bedrooms to be in good repair. 1 of 5 bedrooms was observed to have holes on the wall where the electrical sockets are located. Electrical sockets were observed to not have covering. The drawer was also observed and the top drawer did not have a cover. Also on the window sill, there were scratch marks. During this visit, LPA observed R1 trying to rip the fabric part of their headboard by hand and teeth. Substantiated LPA Valerio reviewed pictures obtained from 10/24/24 visit. LPA observed the side gate to be in disrepair. The side gate drags on the floor once it is open. LPA observed holes in the wall located in R1's bedroom. The holes were located next to an electrical socket, leaving the electrical socket exposed to residents in care. According to an interview with an outside agency (OA), OA had similar observations of the facility as LPA Villanueva. The OA representative stated the place was a mess. There were dressers broken, bed sheets had holes in them, and there were scratch marks on the window frame. According to an interview with Administrator Beatrice, Administrator Beatrice stated the damage that occurred in the bedroom were made by R1 due to R1's behaviors. On 11/05/2024, LPA Valerio observed R1's bedroom. LPA observed the holes next to the electrical socket to be repaired; however, the electrical socket was missing a cover. LPA observed the scratches on the window frame and bed frame still is disrepair. LPA Valerio observed the resident bathroom located in the hall. Based on interviews and observation, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8) are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided. An exit interview was conducted, and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Nov 5, 2024 · control 27-AS-20241017164426

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Dec 5, 2024

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times… This requirement was not met as evidenced by: Based on observations and interviews, the licensee did not ensure to keep the 1 out of 5 bedrooms in good repair at all times. This poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 5, 2024

Plan of correction: Licensee stated administrator will have all repairs fixed by POC due date. Administrator will create a plan of fixing any property destruction right away if there is any immediate concern.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: POC

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a case management visit to clear Plan of Corrections from visit 10/24/24 . LPA Valerio met with facility staff Etta, and explained the purpose of the visit. LPA Valerio was later met by Administrator Beatrice. On 10/24/24, the facility was cited for 87705(f), 87303(e )(2), and 87705(I)(6). LPA Valerio received staff training for 87705(f) and training for 87705(I)(6). On 11/01/2024, Administrator Beatrice provided hot water readings for 10/25 - 11/01, which read between 105.0 - 120.0 degrees F. On 11/05/24, LPA Valerio measured the hot water temperature in two bathrooms. Bathroom 1 measured at 105.4 degrees F. Bathroom 2 measured at 106.9 degrees F. Based on records review and observations, the plan of corrections (POC) have been cleared. A POC letter was provided to Administrator Beatrice. No deficiencies were cited. An exit interview was held, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 5, 2024

Type of visit: Case Management - Deficiencies

On 10/24/24, Licensing Program Analyst (LPA ) arrived unannounced to this facility to conduct a case management visit. LPA initially met with staff on duty (S1) and stated the purpose of the visit. Beatrice Clark, Administrator (AD) was notified of the visit and arrived shortly after. Present during today's visit were 5 residents in care with 1 staff on duty (S1). The purpose of this visit is to cite deficiencies found during a complaint investigation visit (complaint #27-AS-20241017164426) on 10/24/24. During this visit, LPA and AD conducted an inspection of the facility including resident bedrooms, bathrooms, kitchen, dining, livingroom, garage and outside perimeter. During the inspection of the kitchen, LPA observed cleaning chemicals stored under the sink. The storage under the sink does not have a lock and the chemicals are accessible to residents in care. S1 removed the cleaning chemicals and stored them in a locked closet in the hallway leading to the garage door. During an inspection of the bathroom located in the resident bedroom hallway, LPA observed 2 disinfectant sprays and a cleaning spray bottle under the bathroom sink storage. This storage was unlocked and accessible to residents in care. S1 removed the chemical items and store them inside a locked closet in the hallway leading to the garage door. Photos were taken for reference. LPA also inspected the kitchen pantry and refrigerator and freezer. LPA did not observed medications stored the refrigerator. LPA measured the hot water in the hallway bathroom and was measured at 123*F. LPA and AD measured the hot water in the master bathroom and was measured at 123*F. LPA and AD also inspected the outside of the facility. Fence and gates were observed to be in good repair at this time. LPA observed the gate was locked by the evidence of the latched being tied with a string. AD attempted to loosen up the tie but were not able to. Per AD there was a former resident who tends to climb up the fence but has moved out more than a week ago. AD stated they forgot to unlock the gate. During this visit, S1 cut and removed the string off the gate latch. Per California Code of Regulations (CCR) Title 22, deficiencies are being cited today on the attached LIC 809-D page. An exit interview was held with Administrator Beatrice, and a copy of report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 24, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f) · Plan of correction due date: Oct 25, 2024

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia:(1) Knives,...tools and other items that could constitute a danger to the resident(s).(2)... cleaning supplies and disinfectants. This requirement was not met as evidenced by: Based on observations, the licensee did not comply with the regulation cited above. LPA Villanueva observed cleaning supplies under the kitchen sink and under the bathroom sink area accessible to the residents in care. This poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 24, 2024

Plan of correction: During this visit, staff on duty removed the cleaning chemicals and store them in a locked closet. Per Administrator they plan to train staff and put lock for the storage under the sink. Per Administrator, they will send their plan to the Department by POC due date. Then send the staff training once completed by 10/31/24.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87303(e)(2) · Plan of correction due date: Oct 25, 2024

(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). Based on observation, the licensee did not comply with the regulation cited above. Hot water in 2 bathrooms and kitchen sink were measured betwween 123*F and 125*F. This poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 24, 2024

Plan of correction: Per discussion with Administrator, initially, check daily for a week and send readings to LPA by 10/31/24. After that, check hot water every month to continue monitoring hot water. Per Administrator, they will send their plan to the Department by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(l)(6) · Plan of correction due date: Oct 25, 2024

(6) Locked exterior doors or perimeter fences with locked gates shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents. Based on observation, the licensee did not comply with the regulation cited above. LPA observed the gate latch to be locked as evidenced by being tied with a string.the state’s words, verbatim · CDSS document, Oct 24, 2024

Plan of correction: The staff has already removed the lock. The Administrator/Licensee agrees to send the date and time of when she will provide a training on fire safety regarding exits and fire department fire access by the POC date.

Allegation investigated: Facility staff do not do activities with the residents Facility floor is a tripping hazard Facility shower is in disrepair Facility records are not available and maintained

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint findings. LPA Valerio met with Administrator Beatrice Clark, and explained the purpose of the visit. The investigation consisted of interviews with staff, interviews with residents, records review, and observations. The following has been determined as it related to the above-mentioned allegations. Facility staff do not do activities with the residents LPA Valerio observed the facility on 06/13/2024, 07/02/2024, 07/23/2024, and 08/29/2024. During those visits, LPA did not observe staff conducting activities with the residents. Each time LPA visited, there was one staff on shift. The staff member was busy preparing meals, completing household chores, assisting residents with Activities of Daily Living (ADLs), and assisting with any outside agency visits. Continues on LIC 9099 - C Substantiated ...continued from 9099 LPA did not observe a time where staff could be made available to conduct an individualized activity with a resident. The only activity that was observed was staff turning on the television for residents to watch a show or movie or playing music on the television. According to an interview with S1, S1 stated the residents do not like the activity schedule and it has to be personal to each person. S1 stated they do activities. According to an interview with Administrator Beatrice, the facility does activities such as bingo days, music, or take them out to an outing. Administrator Beatrice stated that a staff member that used to work at the facility was the main person to do activities but that staff left earlier in the year. Facility floor is a tripping hazard On 06/13/2024, LPA Valerio observed the facility. The facility has a fire door located in between the living room and the back of the house where the resident rooms are located. The fire door is raised a few inches from the floor. On one side of the door way, there is a door threshold that acts as a ramp so residents can move from the resident rooms to the living area. However, if a resident where to go from the living room to the resident room area, a door threshold ramp is not present. During this visit, LPA Valerio observed a resident in a wheelchair attempting to go back to the bedroom. The resident was unsuccessful because the resident was unable to move the wheelchair across the door way. According to Administrator Beatrice, the fire marshal required the fire door to be installed as such in order to be granted a fire clearance. According to review of Regional office visit on 06/13/2023, the facility was required to install two thresholds on the fire door. Prior to receiving licensure, the deficiency was correct. However, based on LPA Valerio's observation there is only one door threshold instead of two. Continues on LIC 9099- C, page 3... ...continued from LIC 9099 - C, Page 2 Facility shower is in disrepair LPA Valerio observed the facility on 06/13/2024. The facility shower located bedroom 3 was observed to be in disrepair. The ramp leading in to the shower had tiles that were sunk into the floor and covered by a plastic shower skid matt. According to Administrator Beatrice, residents do not use the shower and it was in process of getting fixed. The facility has one other bathroom residents use to shower with staff assistance. On 07/02/2024, LPA Valerio observed the facility shower to be in process of getting fixed. Residents were able to use the toilet but were restricted access to the shower until it was repaired. As of today's date, 09/17/2024, the shower has been fixed by the licensee. Facility records are not available and maintained During LPA's visit on 06/13/2024, Administrator Beatrice admitted that the files were not complete; however, she had the documents on her phone. Administrator Beatrice stated that residents got into the facility files and took all the papers out of the binder. LPA observed a tub full of paperwork for resident files and staff files. Administrator Beatrice was not able to provide LPA copies of staff or resident files until 07/02/2024. Based on interviews and observation, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8) are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided. An exit interview was conducted, and a copy of the report was left at the facility. Insufficient staff to meet the needs of the residents On 06/13/2024, Resident 1 (R1) was observed playing with a trash can in a bathroom, climbing on a bed in another resident's room, aimlessly walking around the facility , and trying to exit the exit door to the backyard. During this time, S1 was observed doing the facility laundry and placing clean bedsheets on resident bedrooms. On 08/29/2024, LPA Valerio waited outside the facility for 10 minutes before staff answered the door. According to S1, S1 was cleaning a resident room and could not answer the door. Residents were observed sitting at the dining table and waved to LPA. LPA Valerio observed S1 assisting R1 with a shower. While this was happening, two residents were finishing their breakfast, one was in their room watching television, and another was sleeping. The Administrator and S2 arrived to the facility to meet with LPA; however, if they were not present, S1 would have pre-occupied for 15-20 minutes and unable to assist any other resident in care. According to Administrator Beatrice, the facility has enough staff. Beatrice states she is always there and goes back and forth between the Elk Grove Facility and Galt Facility. Staff 2 (S2) comes during the evening after S1 has completed the shift. According to an interview with S1, S1 feels that S1 can take care of all the residents and all duties of the facility. Due to cognitive impairment of the residents, LPA was only able to successfully interview Resident 2 (R2). R2 stated that it takes about 5 minutes for staff to respond to calls. R2 does not have any concerns of the facility and stated staff help R2. Licensee allows non-fingerprinted staff to assist residents It was reported to the Regional Office that the facility had an employee who is not cleared to work in the facility. LPA Valerio observed the facility on 06/13/2024, 07/02/2024, 07/23/2024, and 08/29/2024. LPA observed all staff present in the facility to have a finger print clearance and associated to the facility. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview was held and a copy of report was left at the facility.the state’s words, verbatim · CDSS document, Sep 17, 2024 · control 27-AS-20240605150140

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87219(a) · Plan of correction due date: Oct 21, 2024

87219 Planned Activities (a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include:...This requirement was not met as evidenced by: Based on LPA observation, the facilty did not conduct activities with residents during 4 out of 4 visits, which poses a potential health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 17, 2024

Plan of correction: Licensee will send proof of conducting activities with residents and have staff document outings by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 21, 2024

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... This requirement was not met as evidenced by: Based on interviews and observations, the licensee did not ensure 1 out of 2 showers were maintained in good condition, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 17, 2024

Plan of correction: Licensee had the shower repaired. It was observed to be in good condition during LPA's visit on 07/02/2024. POC cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(d)(6) · Plan of correction due date: Oct 21, 2024

87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement was not met as evidenced by: Based on observations and records review, The licensee did not ensure the firedoor was free from obstructions by having door thresholds on each side of the door. This poses a potential health, safety, and personal rights risk to resident in carethe state’s words, verbatim · CDSS document, Sep 17, 2024

Plan of correction: Licensee removed the entire threshold so that it is a flat surface. LPA observed the change during 09/17/2024. POC cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506 · Plan of correction due date: Oct 21, 2024

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility ... This requirement was not met as evidenced by: Based on interviews and observations, the licensee did not ensure to maintain a complete record for all residents and staff, which poses a potential health, safety, and personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Sep 17, 2024

Plan of correction: Licensee submitted completed resident files to LPA Valerio during annual visit on 07/02/2024. POC cleared.

Allegation investigated: Facility staff did not ensure resident was treated with dignity

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint investigation findings. LPA Valerio met with facility staff, and explained the purpose of the visit. Administrator Beatrice stated staff can sign on her behalf. The investigation consisted of interviews with the Reporting Party (RP), interviews with residents, Resident 1 (R1) - Resident 4 (R4), interviews with staff, Staff 1 (S1) - Staff 2 (S2), and observations of staff to resident interactions. According to an interview with the RP, the RP was visiting a resident. The RP observed two staff on shift. While the RP was talking to the resident, the RP heard a someone in the back room yell in a loud tone, "Go to your room!" RP said the staff that was in the kitchen did not react. Continues on LIC 9099 - C... Unsubstantiated Continued from LIC 9099 A few minutes later, the same person yelled again. The RP did not see what happened and only heard it. RP stated if any of their team members reacted that way to a resident, that person would not have a job. It was very unprofessional. RP could only provide the ethnicity and gender of the person believed to yell at the resident. LPA Valerio interviewed four (4) residents. Based on interviews with R1, R2, R3, and R4, there was no indication or proof that staff have yelled at the residents or raised their voice at the resident. LPA Valerio interviewed two (2) staff. Per S1, S1 stated the allegation is not true. S1 knows that S2 talks loudly but because some residents cannot hear and need to hear the words. S1 stated R4 needs staff to speak slow and loud so R4 can read the lips. S1 stated there is not a staff member that matches the RP description. S2 stated S2 has never yelled at the resident when talking to them. LPA Valerio observed the facility on 05/29/2024, 06/13/2024, and 07/02/2024. LPA observed staff interactions to be professional, attentive, and caring. It should be noted that LPA observed Staff 2 to be the only person on shift during the visits. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was held and a copy of report was left at the facility.the state’s words, verbatim · CDSS document, Jul 23, 2024 · control 27-AS-20240528100935

Allegation investigated: Facility HVAC system is in disrepair

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a 10-Day Visit/Complaint Investigation. LPA Valerio was met by facility staff, and explained the purpose of the visit. Administrator Beatrice stated staff can sign on her behalf. The Regional Office received notification from the Reporting Party (RP) regarding the temperature at the facility being between 96-97 degrees Fahrenheit on 07/18/2024. The RP stated the facility thermostat was blank and used a Thermal Imaging Camera to capture the temperature of the room. It was reported that staff called emergency services due to Resident 1 (R1) having a fever. R1 was transferred to the hospital. The RP heard Administrator Beatrice tell staff to ensure that no other residents were spoken to by the RP. LPA Valerio obtained copies of the pictures obtained from the RP. Pictures revealed the readings of the room temperature and the thermostat to be inoperable. Continues on LIC 9099 - C... Substantiated Continued from LIC 9099 On 07/22/2024, LPA Valerio received a telephone call from Administrator Beatrice regarding inquires on placing a plastic lock box on the facility thermostat. Per Administrator Beatrice, the residents messed with the thermostat and turned the heat to 85 degrees. Administrator Beatrice stated it was never broken and she always would like to keep the temperature at 72-73. On 07/23/2024, Administrator Beatrice stated that the thermostat was not 96 degrees and the facility was 86 degrees. On 07/23/2024, LPA Valerio observed the facility thermostat. The temperature inside the facility was degrees 80 degree Fahrenheit; however, the temperature was set to 68 degrees. LPA took a picture for reference. On 07/23/2024, the temperature outside was 102 - 107 degrees, which means the temperature inside the facility should be between 72 - 77 degrees. According to an interview with Staff 1 (S1), S1 stated that S1 was not working when the incident happen but heard the air conditioning was broken for only three hours. S1 stated they are told set the thermostat to 68 degrees. S1 says the plastic box was put on and it is programmed so it cannot go higher or lower. Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached LIC 9099-D page. An exit interview was held, and a copy of the report was provided. Appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 23, 2024 · control 27-AS-20240720162624

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(b)(2) · Plan of correction due date: Jul 24, 2024

87303 Maintenance and Operation(b) A comfortable temperature for residents shall be maintained at all times.(2).., between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature. This requirement was not met as evidenced by: Based on records review and interviews, the licensee did not ensure the facility temperature was comfortable for residents, which poses an immediate health, safety. and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 23, 2024

Plan of correction: Licensee stated a new thermostat batteries was purchased and installed. Licensee to send LPA pictures of thermostat reading every afternoon from 07/24/2024 - 08/16/2024. Plan of Corrections was discussed with Administrator Beatrice via cell phone.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required visit. LPA Valerio met with facility staff Etta M., and explained the purpose of the visit. LPA Valerio was later met by Administrator Beatrice Clark. LPA Valerio observed facility staff serving breakfast to residents, cleaning the facility, and assisting residents with ADLs. LPA Valerio toured the physical plant to ensure compliance with Title 22 regulations. LPA Valerio observed the kitchen to be clean. The facility was observed to have an adequate supply of food. LPA Valerio observed residents bedrooms to be fully furnished, clean, and free from odors. Beds were observed to have clean sheets, blankets, and pillow covers. LPA Valerio observed two resident bathrooms. The bathroom located in room 3 had a recent repair of the shower floor. According to the Administrator, the shower is off limits until the floor is completely fixed. LPA Valerio took a picture for reference. The second bathroom located outside of resident bedrooms was observed to be fully operational. Hot water was measured at 115.0 degree F. The temperature inside the home was 70 degrees F. Door alarms were observed to be in working condition. Carbon monoxide detector, fire extinguisher, and fire detector were in working condition and had a last annual inspection on 04/15/2024. LPA Valerio reviewed 3 staff files. 3 out of 3 staff files did not have an active first aid certificate. Staff completed CPR/First aid prior to LPA's departure from the facility. A Technical Violation Advisory Note was provided to Administrator Beatrice. LPA Valerio reviewed 5 resident files. 5 out of 5 resident files had an up to date assessment and appraisal. LPA Valerio requested the following annual documentation be sent to the Regional Office by 07/12/2024: LIC 500, LIC 308, LIC 610D Per California Code of Regulations (CCR) - no deficiencies are being cited on today's visit. A Technician Violation Advisory Note was provided. An exit interview was held with Administrator Beatrice, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 2, 2024

Type of visit: POC

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a Plan of Correction Visit. LPA Valerio met with facility staff Etta Mae, and explained the purpose of the visit. LPA was later met by Administrator Beatrice Clark. The facility was cited on 05/29/2024 for 87307 Personal Accommodations and Services, 87705 Care of Persons with Dementia, and 87468.1 Personal Rights of Residents in All Facilities. LPA Valerio observed the facility. LPA Valerio observed all beds to have clean a bed cover, bed linen, a blanket, and pillows. LPA observed the kitchen to have sharps locked away and inaccessible to residents in care. LPA observed cleaning supplies locked in the cabinets. LPA observed the housekeeper mopping the floors. LPA did not observe toxins accessible to residents . Administrator Beatrice showed LPA a copy of the statement confirming an in-service training was held with facility staff for Personal Accommodations and Services, Care of Persons with Dementia, and Personal Rights of Residents in All Facilities. An exit interview was held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 13, 2024

Allegation investigated: Facility staff do not ensure residents have bedsheets

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct a 10-Day Complaint Investigation. LPA Valerio met with facility staff Etta Mae, and explained the purpose of the visit. LPA Valerio was later met by Administrator Beatrice Clark LPA Valerio requested the following documentation: LIC 500 Personnel Report, LIC 9020 Register of Facility Clients/Residents, Staff Schedule for May 2024, Staff files for Staff 1 (S1) - Staff 2 (S2), Resident File for Resident 1 (R1), Resident 2 (R2), Resident 3 (R3), Resident 4 (R4), and Resident 5 (R5). Staff Files to include copy of identification, copy of application, and description of duties. Resident File to include admission agreement, LIC 602 Physician's Report, and Appraisal/Needs and Services Plan LPA Valerio observed the facility. Upon arrival, facility staff was observed by LPA Valerio to be sweeping the front outside area of the home. Continues on LIC 9099 - C... Substantiated Continued from LIC 9099 There were 3 residents sitting in the kitchen area enjoying coffee. There was another staff that exited the facility once LPA Valerio arrived. According to an interview with facility staff and administrator, the person was a housekeeper and not a caregiver. LPA observed 5 bedrooms. LPA observed 3 out of 5 bedrooms to have beds without bedsheets, linens, or pillows. LPA observed 1 resident laying on a mattress without any pillows or blankets. According to an interview with Staff 1 (S1), there are plenty of extra linens in the closet. S1 reported they are unsure why it was not replaced after the soiled bedsheets were taken off the bed. S2 reported that staff clean the bedsheets every day. S2 said they will put the bedsheets on after they clean. S2 showed LPA the closet where extra linen supplies were observed. LPA observed multiple bed covers, bed sheets, and bed comforters that can be utilized. According to an interview with the Reporting Party (RP), RP observed the facility. RP observed a resident on a bed that did not have any bedsheets. RP observed another bedroom that had two beds with out anything on them. The observations from the RP prior visit were similar to LPA's observation on 05/29/2024. Based on observations and interviews, the preponderance of evidence standard has been met, therefore the Department has determined the allegation of Facility staff do not ensure residents have bedsheets to be substantiated. Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided. An exit interview was held with Administrator Beatrice Clark, and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, May 29, 2024 · control 27-AS-20240528100935

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a)(3)(C) · Plan of correction due date: Jun 12, 2024

87307 Personal Accommodations and Services (a)...(3)... supplies.. shall be readily available to each resident.... (C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads... this requirement was not met as evidenced by: Based on observations and interviews, the licensee did not ensure 3 out of 5 bedrooms to have clean linen available for the residents to use at all times. This poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 29, 2024

Plan of correction: Licensee stated an in-service training will be conducted with all staff regarding proper procedures when changing out bed linens. LPA Valerio to receive a copy of the in-service sign in sheet by POC due date.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct a case management visit. LPA Valerio met with facility staff Etta Mae, and explained the purpose of the visit. LPA Valerio was later met by Administrator Beatrice Clark. 05/29/2024, LPA Valerio was initially at the facility to conduct a 10-Day Complaint Investigation related to Complaint # 27-AS-20240528100935. During the facility walk through, LPA Valerio observed multiple health and safety concerns. Pictures were taken for future reference. On top of the kitchen counter, LPA observed 2 gallon bleach containers, a spray bottle labeled bleach, and a screw driver next to the kitchen sink. On the dryer rack located near the kitchen sink, LPA Valerio observed a large kitchen knife. During an interview with a resident, LPA observed ants crawling on the table and on the resident's hand. The resident was unaware of the ants until LPA Valerio pointed it out. According to an interview with Administrator Beatrice, the pest control service was last at the facility 6 months ago, staff clean daily, and they have a housekeeper that cleans frequently. Technical Assistance provided for 87555(b)(27). LPA Valerio observed a nail screwed into the wall in front of a resident bathroom door and a bedroom door. The bedroom door was learned to be used for live-in care staff. Behind the door, LPA observed a rope tied to the doorknob. LPA Valerio asked Staff 2 (S2) to demonstrate the reason behind the rope and nail. S2 showed that the facility takes the rope and ties it over the nail. S2 stated it is used for staff privacy when using the restroom or inside the staff room due to the doors being unable to lock. Administrator Beatrice and Staff 2 denied that the nail and rope are used if a resident is inside. Administrator Beatrice stated she reminded staff multiple times to never install the nails and have repeatedly told them to not use it in the past. Administrator removed the rope and nails during the visit. Per California Code of Regulations (CCR) Title 22, deficiencies are being cited today on the attached LIC 809-D page. Appeal Rights were provided. An exit interview was held with Administrator Beatrice, and a copy of report was provided to the Administrator.the state’s words, verbatim · CDSS document, May 29, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f) · Plan of correction due date: May 30, 2024

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia:(1) Knives,...tools and other items that could constitute a danger to the resident(s).(2)... cleaning supplies and disinfectants. This requirement was not met as evidenced by: Based on observations, LPA Valerio observed, cleaning supplies, a knife, and a tool out on the kitchen area accessible to the residents in care. This poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 29, 2024

Plan of correction: Licensee had staff lock away the sharps and cleaning supplies during the visit. Licensee to submit a Training Plan by POC due date. The plan will describe when training related to 87705 will be held with all staff.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.1(a)(6) · Plan of correction due date: May 30, 2024

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (6)... to not be locked into any room, building, or on facility premises by day or night. This requirement was not met as evidenced by: Licensee did not ensure facility staff did not install a locking mechanism on the resident bathroom and bedroom. This poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 29, 2024

Plan of correction: Licensee removed nails and ropes during LPA's visit. Licensee to submit a Training Plan by POC due date. The Training Plan will describe when an all staff training will be held regarding 87468.1 Personal Rights of Residents in All Facilities.