Beit Shalom Group

Allegation investigated: Staff did not ensure that a resident in care was receiving oxygen. Staff did not adequately supervise a resident in care.

On 01/29/26, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint visit to further investigate the above mentioned allegations and deliver findings. LPA met with Lucy Ouw, Caregiver, explained the purpose of the visit, and was granted entry to the facility. The investigation consisted of the following: On 11/21/25, LPA Gonzalez obtained copies of the staff roster, and resident roster. LPA Gonzalez reviewed service records for resident #1 (R1) and requested the following documents: Physician’s Report, Needs and Services Plan, Admission Agreement, Death Report, Special Incident Reports, and medical records from Cedars Sinai Hospital for the visits on 09/30/25, 10/18/25. LPA Gonzalez reviewed service records for residents #2-#6 (R2-R6) and obtained copies of the following documents: Physician’s Report and Needs & Services Plan. Continued on LIC9099-C Unsubstantiated Additionally, LPA Gonzalez interviewed staff #1-#4 (S1-S4), residents #2-#4 (R2-R4), and attempted to interview witness #1-#2 (W1-W2). LPA Gonzalez was unable to interview R1. Furthermore, LPA Gonzalez and Lucy Ouw toured the facility. On 01/29/26, LPA Gonzalez received the following records: Physician Order Form from TLC Hospice Care, Inc. (dated: 10/25/25). The investigation revealed the following: For the allegation: Staff did not ensure that a resident in care was receiving oxygen. It is being alleged that staff did not ensure that a resident was receiving oxygen or that the resident’s oxygen levels were appropriate. On 11/21/25, LPA Gonzalez conducted interviews with S1-S4. Of those interviewed, 4 out of 4 staff denied the allegation. 4 out of 4 staff stated that they followed all physician orders and directives while caring for R1. On 11/21/25, LPA Gonzalez conducted interviews with R2-R4 and was unable to interview R1 as they passed away on 10/28/25. Of those interviewed, 3 out of 3 residents could not corroborate with the allegation. 3 out of 3 residents stated that staff is providing the necessary care and supervision. On 11/21/25, LPA Gonzalez conducted a review of records. Medical records from Cedars-Sinai Hospital dated 10/08/25 indicated that R1 was admitted on 09/30/25 due to swelling in the hands and legs and was discharged on 10/08/25 with diagnoses of Atrial Fibrillation (AFib) and Urinary Tract Infection (UTI). Medical records from Cedars-Sinai Hospital dated 10/25/25 noted that R1 was admitted on 10/19/25 due to low oxygen saturation levels and hypotension. R1 was discharged from the hospital on 10/25/25 under hospice care. A review of the Unusual Incident/Injury Report (UIR) dated 09/30/25 noted that R1 was experiencing severe swelling in the hands and legs and was transported to Cedars-Sinai Hospital for evaluation. The UIR dated 10/08/25 documented that R1 returned to the facility from Cedars-Sinai Hospital on 10/08/25. The UIR dated 10/19/25 indicated that R1 was transported to Cedars-Sinai Hospital due to low oxygen saturation levels observed by staff. The UIR dated 10/25/25 noted that R1 was discharged from Cedars-Sinai Hospital and returned to the facility on 10/25/25 under hospice care with comfort-focused orders. Continued on LIC9099-C The report further noted that R1’s oxygen saturation levels remained low upon discharge and required continuous oxygen to maintain comfort and adequate breathing. Staff ensured oxygen therapy was administered immediately upon arrival per physician and hospice orders. The UIR dated 10/28/25 noted that staff observed R1 with very low oxygen saturation levels despite continuous oxygen therapy, and R1 passed away that afternoon. A review of the Death Report (LIC 624), dated 11/03/25, reported that R1 passed away on 10/28/25 at 5:30 p.m., with contributing factors noted as Alzheimer’s disease and decline. On 01/29/26, LPA Gonzalez received and conducted a review of Physician Order Form from TLC Hospice Care, Inc. (dated: 10/25/25). Record revealed that R1 was prescribed oxygen inhalation as needed for shortness of breath. Based observation, interviews conducted, and records reviewed, there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the above allegation is unsubstantiated. For the allegation: Staff did not adequately supervise a resident in care. It is alleged that a resident with Diabetes was able to access a large amount of sweets at the facility without staff awareness. On 11/21/25, LPA Gonzalez conducted interviews with S1-S4. Of those interviewed, 4 out of 4 staff denied the allegation. 4 out of 4 staff said they follow the resident’s restrictive diets. 4 out of 4 staff said residents do not have access to a large amount of candy or sweets. An interview with S1 revealed that staff supervise residents and take precautions to ensure resident safety. S1 stated that ongoing training is provided to facility caregivers and that staff attempt to follow the household menu as closely as possible. S1 reported that residents’ prescribed diets are posted above each resident’s bed and on the resident’s room door. S1 further stated that staff may advise and remind residents regarding their dietary needs; however, staff do not have control over residents’ decisions to order takeout food or purchase their own groceries, which S1 stated is the residents’ right. Continued on LIC9099-C On 11/21/25, LPA Gonzalez conducted interviews with R2-R4 and was unable to interview R1 as they passed away on 10/28/25. Of those interviewed, 3 out of 3 residents could not corroborate with the allegation. 3 out of 3 residents said that facility staff follow their restrictive diet. 3 out of 3 residents stated that staff is providing the necessary care and supervision. On 11/21/25, LPA Gonzalez conducted a tour of the facility. No large quantities of sweets were observed to be accessible to residents. During the tour, LPA observed residents during lunch being served a well-balanced meal consisting of chicken, rice, and vegetables. Based observation, interviews conducted, and records reviewed, there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the above allegation is unsubstantiated. No deficiencies were cited during this investigation. An exit interview was conducted, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 29, 2026 · control 11-AS-20251114151650

Type of visit: Required - 1 Year

On 01/29/26, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced complaint visit to investigate the above mentioned allegation. LPA met with Lucy Ouw, Caregiver, and explained the purpose of the visit. LPA was granted entry to the facility.The facility is licensed to serve six (6) non- ambulatory residents of which (1) maybe bedridden and an approved hospice waiver for 1 resident. There are currently 6 residents in the facility. The facility is a single story home consisting of the following: Four (4) resident bedrooms, two (2) bathrooms, living room, dining room , kitchen, laundry room and an outdoor shaded patio area in the front of the home. LPA Gonzalez toured the entire facility. All resident bedrooms were inspected. LPA observed the bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were inspected and observed to be within Title 22 regulations. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. The water temperature properly measured between 105.0 F and 120.0 F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. The kitchen was inspected and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, sharps, hazardous items, and medications were securely locked and inaccessible to residents. Continued on LIC809-C Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit along with manual was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility's annual Licensing Fees are current. During todays visit LPA did not observe any deficiencies. An exit interview was conducted, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 29, 2026

The state marks this report as 7 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff mishandled a resident's medication Staff unlawfully evicted a resident Staff is not meeting a resident's continence needs Staff are not providing adequate transportation to medical appointments

Community Care Licensing Division (CCLD) conducted an unannounced visit to Beit Shalom Group Facility on 01/23/2025 and was greeted by Administrator Miriam Rudes (S1). CCLD staff explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. The investigation consisted of the following: CCLD staff interviewed Administrator (S1), staff (S1-S3), residents (R1-R6). CCLD staff requested and reviewed copies of the following: Physician Report (dated 08/22/2023), Needs and Service plan (dated 09/01/2024), admission agreement (date 01/09/2025), incident reports (date 12/21/2025 to 1/8/2025), Medication administration record (MAR) (date 01/2025) for 1out of 6 residents. CCLD staff toured the facility with S1. The investigation revealed the following: Unsubstantiated Regarding Allegation #1: Staff mishandled a resident’s medication. It is being alleged that staff mishandled 1 out of 6 resident medications. During the investigation CCLD staff toured the facility and noted no negative interactions between staff and residents. CCLD staff reviewed physician report (date 12/13/2024), needs and service plan (date 12/23/2024), admission agreement (date 01/09/2025), incident reports (date 12/21/2024 to 1/8/2025), MAR (date 1/2025) for 1 out of 6 residents. CCLD staff reviewed resident MAR and could not find any medication errors. 3 out of 3 staff denied the allegation and staff indicate that staff has never had any issues with any resident medications. 3 out of 6 residents indicate no issues regarding medications. 3 out of 6 residents could not be interviewed due to cognitive issues. Regarding allegation #2: Staff unlawfully evicted a resident. It is being alleged that a staff unlawfully evicted 1 out of 6 residents. During the investigation CCLD staff toured the facility and noted no negative interactions between staff and residents. CCLD staff reviewed physician report (date 12/13/2024), needs and service plan (date 12/23/2024), admission agreement (date 01/09/2025) for 1 out of 6 residents. CCLD staff could not locate any eviction notice given to resident. 3 out of 3 staff denied the allegation and staff indicate that staff never evicted any resident. 3 out of 6 residents indicate that staff has never evicted them for cause. 3 out of 6 residents could not be interviewed due to cognitive issues. Regarding Allegation #3: Staff is not meeting a residents continence need. It is being alleged that staff is not meeting 1 out of 6 residents continence needs. During the investigation CCLD staff toured the facility and noted no negative interactions between staff and residents. CCLD staff reviewed physician report (date 12/13/2024), needs and service plan (date 12/23/2024), admission agreement (date 01/09/2025) for 1 out of 6 residents. CCLD staff reviewed admission agreement for resident, facility states that incontinence supplies are not supplied by facility. Reviewed email between facility and resident conservator date 1/10/2025, email suggest that the facility will order supplies with insurance and resident family will need to pay for supplies not covered by insurance. 3 out of 3 staff denied the allegation and staff indicate that staff never had any issues with resident incontinence needs. 3 out of 6 residents indicate that they do not need incontinence supplies. 3 out of 6 residents could not be interviewed due to cognitive issues. Regarding Allegation #4: Staff are not providing adequate transportation to medical appointments. It is being alleged that staff are not providing 1 out of 6 residents transportation to medical appointments. During the investigation CCLD staff toured the facility and noted no negative interactions between staff and residents. CCLD staff reviewed physician report (date 12/13/2024), needs and service plan (date 12/23/2024), admission agreement (date 01/09/2025) for 1 out of 6 residents. CCLD staff reviewed admission agreement, page 1 section 2 “basic services”, indicates plan and arrange transportation to medical and dental appointments (paid by client), which was signed by resident conservator on 1/10/2025. 3 out of 3 staff denied the allegation and staff indicate that staff does not provide transportation for resident’s doctors’ appointments. 3 out of 6 residents indicate that staff does supply transportation for doctors’ appointments. 3 out of 6 residents could not be interviewed due to cognitive issues. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegations of “staff mishandled a resident’s medication”, “staff unlawfully evicted a resident”, “staff is not meeting a residents continence need”, “staff are not providing adequate transportation to medical appointments” is found to be UNSUBSTANTIATED. No deficiencies cited during today's visit. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Miriam Rudes S1.the state’s words, verbatim · CDSS document, Jan 23, 2025 · control 11-AS-20250120231723

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Miriam Rudes, Administrator and the purpose of the visit was discussed. Facility is licensed to serve 6 non- ambulatory residents of which (1) maybe bedridden and an approved hospice waiver for 1 resident. (1) of the residents are diagnosed with dementia, 2 residents are receiving home health and (1) resident receives hospice care services. The facility does not handle any of the residents’ money. This home is a single story home consisting of: (4) resident bedrooms, (2) bathroom, living room, dining room , kitchen, laundry room and an outdoor shaded patio area in the front of the home. LPA toured the Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured at 108.1F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. During todays visit LPA did not observe any deficiencies. Exit interview conducted with Lucy Ouw, caregiverthe state’s words, verbatim · CDSS document, Dec 19, 2024

Allegation investigated: Staff did not ensure resident received his cash resources

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Monday, December 09, 2024, to amend the original complaint reports dated 08/28/2024 and 10/03/2024. This amended complaint report LIC9099 and LIC9099Cs dated 12/09/2024 will supersede the original documents. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a risk assessment Based on the evaluation, the facility is cleared of COVID-19 infection. LPA Bunker met with staff Ina Hamsiah. LPA Bunker explained the purpose of today's visit. The investigation consisted of the following: During the course of the investigation, interviews were conducted with staff members 1-2 (S1-S2) and residents 1-5 (R1-R5). LPA Bunker asked questions relevant to the nature of the complaint. S1 stated that the resident received all cash resources but would leave the facility for days without picking up the checks. S2 states that she was not aware of the incident, as she did not work at the facility during that time. LPA Bunker reviewed and observed the resident's records and requested copies of supporting documents. See continued LIC9099-C page 2 Unsubstantiated Continued LIC9099-C page 2 Allegation: Staff did not ensure that the resident received his cash resources Interviews were conducted with staff members S1 and S2, as well as residents R1 through R5. who stated that residents received all their cash resources. S1 stated that R1 received all cash resources and explained that she provided R1 with his checks, which he refused to pick up. S1 further stated that R1 had a bank account with Bank of America, where R1 SSI checks were deposited. S1 stated that R1 was not cashing the checks and would often leave the facility for several days or even up to a week. S1 denied owing R1 $3,000.00, referencing a letter from R1 stating, “To tell you the truth, I straight forgot about them. Please send me another set.” S1 stated that R1 provided a new mailing address, and the checks were sent to R1's current address. S1 stated that R1 moved out in March 2023. S1 stated that this incident occurred two years ago and was reported to Community Care Licensing and other appropriate agencies in a timely manner. S1 stated that the issue had been resolved. Residents 2-5 (R2-R5) stated they had no issue with their cash resources, as their family members handled their finances. In an interview with R1, R1 admitted to receiving cash resources and stated that the complaint was made out of frustration and anger. R1 acknowledged that all money was received and that the issue had since been resolved prior to the complaint. LPA Pamela Bunker requested, observed, and conducted a thorough review of the resident's file folder, including the physician's report, medical records, admission agreement, identification and emergency information, contact information, medication log, Medication Administration Records (MARs), medical assessment, consent forms, release of resident medical information, appraisal/needs and services plan, safeguards for cash resources, preplacement appraisal information, unusual incident reports, copies of the SSI checks, and the letter from R1 dated 09/12/2023. See continued LIC9099-C page 3 Continued LIC9099-C page 3 Investigation revealed the following: Staff 1-2 (S1-S2) and residents 1-5 (R1-R5) interviews all stated that they received all of their cash resources. S1 stated she was not sued and had no court documents. She explained that she provided R1 with his checks, which R1 refused to pick up. S1 also stated that R1 had a bank account with Bank of America, where R1 would deposit SSI checks directly. S1 and R1 had no court documents for LPA to review. LPA was provided with copies of the checks and a letter from R1 admitting not picking up the checks. S1 stated that R1 checks were at the facility. S1 stated that R1 was not cashing the checks and would often leave the facility for days, sometimes up to a week. S1 denied owing R1 $3,000.00, citing a letter from R1 in which he wrote, “To tell you the truth, I straight forgot about them. Please send me another set.” R1 provided a new mailing address, and the checks were sent to R1's current address. S1 stated that R1 left the facility of his own free will, and S1 stated she even assisted R1 in finding a new placement at a nice facility in the valley. S1 explained that this incident occurred two years ago and was reported to Community Care Licensing and all relevant agencies promptly. S1 emphasized that the issue had already been resolved. R1 acknowledged that checks were received and stated that the issue had been resolved prior to this complaint. S1 denied the allegation that staff did not ensure residents received their cash resources. Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. Copies of the Complaint Investigation Report LIC9099 and LIC9099-Cs were provided to staff. There were no deficiencies cited. Exit interview conductedthe state’s words, verbatim · CDSS document, Oct 3, 2024 · control 11-AS-20231018105832

Allegation investigated: Staff did not ensure resident received his cash resources

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, August 28, 2024. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with staff Ina Hamsiah and spoke to the Licensee Miriam Rudes via telephone. LPA Bunker explained the purpose of today's visit. The investigation consisted of the following: Interviews conducted with staff members 1-2 (S1-S2) and residents 2-5 (R1-R5). S1 stated that the resident received all cash resources but would leave the facility for days without picking up the checks. S2 stated that she was not aware of the incident, as she did not work at the facility during that time. LPA Bunker reviewed and observed the resident's records and requested copies of supporting documents. See continued LIC9099-C page 2 Unsubstantiated Continued LIC9099-C page 2 Allegation: Staff did not ensure that the resident received his cash resources Interviews were conducted with staff members S1 and S2, as well as residents R1 through R5. who stated that residents received all their cash resources. S1 stated that R1 received all cash resources and explained that she provided R1 with his checks, which he refused to pick up. S1 further stated that R1 had a bank account with Bank of America, where R1 SSI checks were deposited. S1 stated that R1 was not cashing the checks and would often leave the facility for several days or weeks. S1 denied owing R1 $3,000.00, referencing a letter from R1 stating, “To tell you the truth, I straight forgot about them. Please send me another set.” S1 stated that R1 provided a new mailing address, and the checks were sent to R1's current address. S1 stated that R1 moved out in March 2023. S1 stated that this incident occurred two years ago and was reported to Community Care Licensing and other appropriate agencies in a timely manner. S1 stated that the issue had been resolved. Residents 2-5 (R2-R5) stated they had no issue with their cash resources, as their family members handled their finances. In an interview with R1, he admitted to receiving cash resources and stated that the complaint was made out of frustration and anger. R1 acknowledged that all money was received and that the issue had since been resolved prior to the complaint. LPA Pamela Bunker requested, observed, and conducted a thorough review of the resident's file folder, including the physician's report, medical records, admission agreement, identification and emergency information, contact information, medication log, Medication Administration Records (MARs), medical assessment, consent forms, release of resident medical information, appraisal/needs and services plan, safeguards for cash resources, preplacement appraisal information, unusual incident reports, copies of the SSI checks, and the letter from R1 dated 09/12/2023. See continued LIC9099-C page 3 Continued LIC9099-C page 3 Due to time constraints, LPA was unable to complete the visit and will return back at a later date to complete the visit. Copies of the Complaint Investigation Report LIC9099 and LIC9099-Cs were provided to staff. There were no deficiencies cited. Exit interview conductedthe state’s words, verbatim · CDSS document, Aug 28, 2024 · control 11-AS-20231018105832

Allegation investigated: Resident sustained pressure injuries while in care. Facility staff did not follow resident's care instructions. Facility staff did not properly bathe resident.

On 07/22/24 Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint visit to gather information pertaining to the above-mentioned allegations and deliver findings. LPA met with Administrator Miriam Rudes and explained the purpose of today’s visit. The investigation consisted of the following: On 03/28/23, LPA Lourdes Montoya reviewed five resident files, and three staff files, and obtained copies of the resident’s roster, staff roster and resident records. LPA Montoya conducted interviews with residents #2-#4 (R2-R4), and attempted to interview residents #1, #5, and #6 (R1, R5, R6). LPA interfviewed witness #1 (W1) and staff #1-#3 (S1-S3). Furthermore, LPA Montoya and Administrator Miriam Rudes toured the inside and outside grounds of the facility. On 07/22/24, LPA Gonzalez attempted to interview reporting party and R1. LPA Gonzalez also requested the Appraisal/Needs and Services Plan (LIC625) for resident R1. Continued on LIC9099-C Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Resident sustained pressure injuries while in care. It is alleged that a resident was at this facility during the dates of 03/15/23-03/22/23 and came home with sores on their buttocks and resident is not able to fully extend their left leg. On 03/28/23 LPA Montoya interviewed S1-S3. (3) out (3) staff said that there were no residents who sustained pressure injuries while in care during the dates of 03/15/23-03/22/23. On 03/28/23 LPA Montoya interviewed R2-R4 and asked if they knew or were aware of any resident sustaining injuries while in care at the facility. (3) out of (3) residents interviewed revealed that no resident had sustained injuries while in care. On 07/22/24 LPA Elvira Gonzalez conducted an interview with Administrator Miriam Rudes and it revealed that R1 was not on hospice or home health during their stay at this facility between the dates of 03/15/23 and 03/22/23. Administrator Rudes stated that when R1 was brought to the facility they had no visible pressure injuries but appeared to be very frail and delicate. On 07/22/24 LPA Gonzalez reviewed the Appraisal/Needs and Services Plan, Physician’s Report for resident R1. Physician’s Report (dated 03/14/23) revealed that R1 requires assistance with all activities of daily living, which includes bathing, toileting, eating, drinking, and medication administration. Physician’s Report also revealed that R1 has a history of skin condition or breakdown with a note under the explanation column stating the buttocks and that R1 had a recent hip fracture. Based on interviews conducted with facility staff, facility clients, and LPA record review, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Continued on LIC9099-C Allegation: Facility staff did not follow resident's care instructions. It is alleged that this facility did not follow instructions in caring for the resident. On 03/28/23 LPA Montoya interviewed S1-S3. (3) out (3) staff said that they follow each resident’s plan of care. On 03/28/23 LPA Montoya interviewed R2-R4 and asked if staff do not follow resident’s care instructions. (3) out of (3) residents interviewed revealed that staff do follow the resident’s care instructions. On 07/22/24 LPA Elvira Gonzalez conducted an interview with Administrator Miriam Rudes and it revealed that the each resident has a plan of care written and is followed thoroughly. Miriam Rudes stated that when R1 arrived at the facility, the facility was provided with a food and beverage thickener from the family. She stated that staff at this facility did use the thickener. Miriam Rudes said that staff made sure that R1 was more than comfortable during their short stay at this facility. Based on interviews conducted with facility staff, facility clients, and LPA record review, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Allegation: Facility staff did not properly bathe resident. It is alleged that a resident was not bathed properly during their stay at this facility. On 03/28/23 LPA Montoya interviewed S1-S3. (3) out (3) staff said that they do bathe residents. On 03/28/23 LPA Montoya interviewed R2-R4 and asked if staff properly bathe residents. (3) out of (3) residents interviewed revealed that staff do properly bathe residents. On 07/22/24 LPA Elvira Gonzalez conducted an interview with Administrator Miriam Rudes and it revealed that the depending on the residents care needs is how often they are bathed. For a bedridden resident they are given a bed bath 3-4 times a week, and if the resident denies a bath, it is not forced. Based on interviews conducted with facility staff, facility clients, and LPA record review, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Based on interviews conducted with facility staff, facility clients, and LPA record review there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held. A copy of the report was provided to Caregiver, Ina Hamsiah.the state’s words, verbatim · CDSS document, Jul 22, 2024 · control 11-AS-20230327091711

Type of visit: Required - 1 Year

On 1/26/2024 at around 10:30 AM, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Licensee/Administrator Miriam Rudes. LPA explained the purpose of the visit and was accompanied by a Caregiver inside and outside the facility during this inspection. This facility is licensed to serve 6 adults ages 60 and over, of which 5 may be non-ambulatory and 1 bedridden. A total of 6 residents are currently residing in this facility. The Annual Licensing Fees are current. The facility is a one-story house located in a residential street. The home consists of 4 resident bedrooms, 1 resident bathroom, 1 living/dining room, 1 kitchen, 1 entrance room, 1 laundry room, 1 staff bathroom, and 1 front patio area with shaded seating. Outside grounds were toured and no bodies of water were observed. The patio furniture is under a shaded area and accessible to residents. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. LPA toured the kitchen area and observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept in locked storage cabinet. LPA observed that medications were safe, locked, and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. Last fire drill was conducted on 11/03/2023. First aid kit is fully stocked. Smoke and carbon monoxide detectors were in compliance and operational. There are two fire extinguishers one is the entrance room and the other is in the kitchen. 4 out of 4 resident’s bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. LPA tested hot water temperature and it measured between 105 and 120 degrees Fahrenheit. This facility provides residents with hygiene products such as feminine napkins, nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb. 5 staff records were reviewed, 5 out of 5 staff records had Criminal Record Clearances, Job Application, Education Information, and Health Screening reports. 5 resident records were reviewed and, 5 out of 5 resident records had Admission Agreements and Medical Assessments, Consent Forms, Weight Record, Emergency Information, Tuberculosis Test, and Centrally Stored Medication Destruction Record. No deficiencies are being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Tittle 22. An exit interview was conducted and a copy of this report was left with the Caregiver.the state’s words, verbatim · CDSS document, Jan 26, 2024