Beth Haven

Type of visit: Case Management - Legal/Non-compliance

On 08/31/26, Licensing Program Analysts (LPA) Melina Oropeza made an unannounced case management visit to this facility. LPA was met by the facility designated Administrator, Janet Johns. A brief interview was conducted with the facility designated Administrator at this time. Current census was 38 residents. 15 residents in Memory Care and 23 residents in Assisted Living. The purpose of this case management visit was to conduct a quarterly visit as outlined from the Non Compliance Conference held on 03/04/2024 and the requirement to have increased monitoring at that time. The focus of this quarterly visit was to review the following items that were initially brought forth on 03/04/2024: Ensure all staff are compliant with all required training Maintain adequate facility staffing Uphold all Personal Rights of the Residents Maintain and conduct Personal Rights training and verification for new and existing employees Facility designated Administrator must maintain oversight of facility staff for proper care and supervision Make sure that this facility is following all Reporting Requirements Updating policies and procedures for resident fall risks Make sure that facility staff are always seeking timely medical attention Update and maintain Needs/Appraisal Training for all staff Maintain and train all care staff on proper documentation for the facility Communication Log LPA was also present today to follow up on incident reports that were submitted for the following residents in care: R1 R2 R3 There were no deficiencies observed or cited during today's case management visit. Exit Interview was conducted with designated administrator, Janet Johns and copies of report were left with designated administrator.the state’s words, verbatim · CDSS document, Aug 31, 2026

Type of visit: Case Management - Legal/Non-compliance

Unannounced case management visit made out to this facility on 05/07/2026 by Licensing Program Analysts (LPA'S) Kesha Lewis and Melina Oropeza who was met by the facility designated Administrator, Janet Johns, at this time. A brief interview was conducted with the facility designated Administrator at this time. Current census was 38 residents. The purpose of this case management visit was to conduct a quarterly visit as outlined from the Non Compliance Conference held on 03/04/2024 and the requirement to have increased monitoring at that time. The focus of this quarterly visit was to review the following items that were initially brought forth on 03/04/2024: Ensure all staff are compliant with all required training Maintain adequate facility staffing Uphold all Personal Rights of the Residents Maintain and conduct Personal Rights training and verification for new and existing employees Facility designated Administrator must maintain oversight of facility staff for proper care and supervision Make sure that this facility is following all Reporting Requirements Updating policies and procedures for resident fall risks Make sure that facility staff are always seeking timely medical attention Update and maintain Needs/Appraisal Training for all staff Maintain and train all care staff on proper documentation for the facility Communication Log There were no deficiencies observed or cited during today's case management visit. Exit Interviewthe state’s words, verbatim · CDSS document, May 7, 2026

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 02/02/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Janet Johns. A brief interview was conducted with the facility designated Administrator at this time. Current census was 38 residents. The purpose of this visit was to follow up on the deficiencies that were cited from a prior case management visit conducted on 01/05/2026. This visit was to follow up on the Plan of Correction that was due. The following deficiency was observed and cited on 01/05/2026: In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. Plan of Correction clearance letter was printed and a copy was provided to the facility designated Administrator at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Feb 2, 2026

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 01/05/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Janet Jones, who was briefly interviewed at this time. It was learned that there were residents under the care of hospice at this time while other residents were receiving services through home health as well. This facility does have a hospice waiver approved for (5) residents and a program, on file, for dementia care unto the residents at any given time. Current census was 41 residents, of which, 29 were in the Assisted Living building (Building A). The other 12 residents, of which (7) were living in Building B and another (5) in Building C were considered as Memory Care. A tour of this facility was conducted alongside the facility designated Administrator Janet Jones. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Janet Jones. Kitchen area was toured. Cabinets and drawers were reviewed. Food preparation stations, dishwashing station, and other areas intended for meal preps were toured. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe additional food storage units which were present and functional at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication rooms, located in each building, were reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications were discussed with the facility designated medication technicians at this time. The medication carts were observed to be locked and made inaccessible to the residents at this time. A tour of the resident bedrooms and restroom was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. It was learned that there were only private and semi-private living arrangements for residents on the Assisted Living portion of this facility. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Linen closet, located in the facility laundry area, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. A tour of the Memory Care buildings, Building B and C, was conducted. Fire extinguishers, located throughout this facility, were observed to have been annually inspected on 05/07/2025 by the local fire extinguisher company, Cisco Fire Sprinklers Inc., and in compliance at this time. First aid kits were observed to be present and contained all of the required components at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gates, and exits was conducted. A review of (7) facility resident files was conducted and noted on the following LIC 858. A review of (7) facility personnel files was conducted and noted on the following LIC 859. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 5, 2026

Type of visit: Case Management - Legal/Non-compliance

Unannounced case management visit conducted on 01/05/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Janet Jones. A brief interview was conducted with the facility designated Administrator at this time. Current census was 41 residents. The purpose of this case management visit was to follow up, with quarterly visits, and inquire about the requirements that were laid out from the office meeting for the non compliance conference which took place back on 03/04/2024. The following items were required to be maintained in compliance while this facility was under increased monitoring with quarterly visits: Maintain adequate facility staffing Uphold all Personal Rights of the Residents Maintain and conduct Personal Rights training and verification for new and existing employees Facility designated Administrator must maintain oversight of facility staff for proper care and supervision Make sure that this facility is following all Reporting Requirements Updating policies and procedures for resident fall risks Make sure that facility staff are always seeking timely medical attention Update and maintain Needs/Appraisal Training for all staff Maintain and train all care staff on proper documentation for the facility Communication Log This LPA was also present today to follow up on several incident reports that were recently submitted for the following residents in care: R1 R2 R3 There were no deficiencies observed or cited during today's case management visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 5, 2026

Type of visit: Case Management - Legal/Non-compliance

Unannounced case management visit conducted on 06/18/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Jose Ventura. A brief interview was conducted with the facility designated Administrator at this time. Current census was 42 residents. The purpose of this case management visit was to follow up, with quarterly visits, and inquire about the requirements that were laid out from the office meeting for the non compliance conference which took place back on 03/04/2024. The following items were required to be maintained in compliance while this facility was under increased monitoring with quarterly visits: Maintain adequate facility staffing Uphold all Personal Rights of the Residents Maintain and conduct Personal Rights training and verification for new and existing employees Facility designated Administrator must maintain oversight of facility staff for proper care and supervision Make sure that this facility is following all Reporting Requirements Updating policies and procedures for resident fall risks Make sure that facility staff are always seeking timely medical attention Update and maintain Needs/Appraisal Training for all staff Maintain and train all care staff on proper documentation for the facility Communication Log This LPA was also present today to follow up on several incident reports that were recently submitted for the following residents in care: R1 R2 There were no deficiencies observed or cited during today's case management visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jun 18, 2025

Allegation investigated: Staff did not ensure that resident was treated with dignity and respect Staff falsified incident report Staff speak inappropriately to residents Staff do not ensure that resident's medication is refilled in a timely manner

Unannounced complaint visit made out to this facility on 04/28/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Jose Ventura, who was briefly interviewed at this time. Current census was 44 residents. The purpose of this visit was to deliver the findings of this investigation to this facility, and it's designated Administrator, at this time. Based on interviews conducted during the course of this investigation, it was learned that R1 has been a resident at this facility for over a year. It was learned that basic care and supervision was provided to R1 as outlined in their plan of care since R1's admission to this facility. Based on interviews, it was learned that there was an incident that took place at this facility involving R1 and R1's family member. During this incident, it was learned that R1 and R1's family member got into a verbal argument resulting in the family member leaving R1's room seeking the counsel of the facility designated Administrator who was present at the time of this incident. It was learned that the facility designated Unsubstantiated Administrator was not directly present in the resident room when the incident took place but did respond and was present to intervene and did overhear the loud voices and strained conversation at that time. It was learned that the police were called and were present to look into this matter since physical violence was alleged at that time. Based on a review of the forms and documents conducted, it was learned that law enforcement did not have sufficient evidence to support the allegations of physical violence and did not take any further actions against any parties that were present during the time of this incident. In addition, law enforcement did not find any evidence that violations were being carried out against the personal rights and dignity of any facility residents at that time. It was learned that law enforcement did not find any evidence that any person, staff or family member, were speaking in a tone or manner which was deemed to be inappropriate at that time. Based on a review of the facility forms and documents, it was learned that the incident reports were filled out and contained all of the required details in relation to this incident which took place in the early part of January 2025. This information was compared to the testimonies of all persons who were present at that time and it was observed to conform to their accounts of the events that took place at that time. Based on a review of the facility medication administration records, it was learned that the medications for R1 were being properly ordered, documented, and dispensed at this time. Based on interviews conducted, it was learned that persons close to R1 felt that this facility was doing their best to meet the demands for R1 even though they felt that it was challenging at times. It was learned that these persons were content with the care and supervision that was being provided to R1 at this time and did not have any complaints. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegations finding of Unsubstantiated meant that although the allegations may have happened or were valid, there was not a preponderance of the evidence to prove that the alleged violations occurred. There were no deficiencies observed or cited at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Apr 28, 2025 · control 27-AS-20250311123231

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 01/31/2025 by Licensing Program Analyst (LPA) Charlie Yang and Regional Manager (RM) Stephenie Doub who was met by the facility designated Administrator, Jose Ventura, who was briefly interviewed. It was learned that there were residents under the care of hospice at this time while other residents were receiving services through home health as well. This facility does have a hospice waiver approved for (5) residents and a program, on file, for dementia care unto the residents at any given time. Current census was 42 residents, of which, 26 were in the Assisted Living building (Building A). The other 16 residents, of which (8) were living in Building B and another (8) in Building C were considered as Memory Care. A tour of this facility was conducted alongside the facility designated Administrator Jose Ventura. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Jose Ventura. Kitchen area was toured. Cabinets and drawers were reviewed. Food preparation stations, dishwashing station, and other areas intended for meal preps were toured. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe additional food storage units which were present and functional at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication rooms, located in each building, were reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications were discussed with the facility designated medication technicians at this time. The medication carts were observed to be locked and made inaccessible to the residents at this time. A tour of the resident bedrooms and restroom was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. It was learned that there were only private and semi-private living arrangements for residents on the Assisted Living portion of this facility. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Linen closet, located in the facility laundry area, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. A tour of the Memory Care buildings, Building B and C, was conducted. Fire extinguishers, located throughout this facility, were observed to have been annually inspected on 05/06/2024 by the local fire extinguisher company, Cisco Fire Sprinklers Inc., and in compliance at this time. First aid kits were observed to be present and contained all of the required components at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gates, and exits was conducted. A review of (10) facility resident files was conducted and noted on the following LIC 858. A review of (10) facility personnel files was conducted and noted on the following LIC 859. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies were observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 31, 2025

Type of visit: Case Management - Legal/Non-compliance

Unannounced case management visit conducted on 01/31/2025 by Licensing Program Analyst (LPA) Charlie Yang and Regional Manager (RM) Stephenie Doub who was met by the facility designated Administrator Jose Ventura. A brief interview was conducted with the facility designated Administrator at this time. Current census was 42 residents. The purpose of this case management visit was to follow up, with quarterly visits, and inquire about the requirements that were laid out from the office meeting for the non compliance conference which took place on 03/04/2024. The following items were required to be maintained in compliance while this facility was under increased monitoring with quarterly visits: Maintain adequate facility staffing Uphold all Personal Rights of the Residents Maintain and conduct Personal Rights training and verification for new and existing employees Facility designated Administrator must maintain oversight of facility staff for proper care and supervision Make sure that this facility is following all Reporting Requirements Updating policies and procedures for resident fall risks Make sure that facility staff are always seeking timely medical attention Update and maintain Needs/Appraisal Training for all staff Maintain and train all care staff on proper documentation for the facility Communication Log There were no deficiencies observed or cited during today's case management visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 31, 2025

Type of visit: Case Management - Incident

Unannounced case management visit conducted on 11/21/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Jose Ventura. Current census was 43 residents. The purpose of this case management visit was to follow up from a complaint investigation that was conducted involving a resident sustaining an injury while in care. After the investigation was conducted, with a review of the evidence that was obtained, this facility was found to be "Unsubstantiated" for the following allegation: Neglect/Lack of Care: Due to staffs' neglect, resident sustained multiple fractures. In addition, this case management visit was conducted to follow up, with quarterly visits, and inquire about the requirements that were laid out from the office meeting for the non compliance conference which took place on 03/04/2024. The following items were required to be maintained in compliance while this facility was under increased monitoring with quarterly visits: Maintain adequate facility staffing Uphold all Personal Rights of the Residents Maintain and conduct Personal Rights training and verification for new and existing employees Facility designated Administrator must maintain oversight of facility staff for proper care and supervision Make sure that this facility is following all Reporting Requirements Updating policies and procedures for resident fall risks Make sure that facility staff are always seeking timely medical attention Update and maintain Needs/Appraisal Training for all staff Maintain and train all care staff on proper documentation for the facility Communication Log There were no deficiencies observed or cited during today's case management visit. Exit Interviewthe state’s words, verbatim · CDSS document, Nov 21, 2024

Type of visit: Case Management - Other

Unannounced case management visit conducted on 09/23/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Jose Ventura. Current census was 37 residents. The purpose of this case management visit was to follow up and inquire about recent incident reports in regards to facility residents and their related care. An interview was conducted with the facility designated Administrator Jose Ventura in regards to these incident reports involving R1 and R2 at this time. There were no deficiencies observed or cited during today's case management visit. Exit Interviewthe state’s words, verbatim · CDSS document, Sep 23, 2024

Type of visit: Case Management - Legal/Non-compliance

Unannounced case management visit conducted on 07/10/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Jose Ventura. A brief interview was conducted with the facility designated Administrator at this time. Current census was 37 residents. The purpose of this case management visit was to follow up, with quarterly visits, and inquire about the requirements that were laid out from the office meeting for the non compliance conference which took place on 03/04/2024. The following items were required to be maintained in compliance while this facility was under increased monitoring with quarterly visits: Maintain adequate facility staffing Uphold all Personal Rights of the Residents Maintain and conduct Personal Rights training and verification for new and existing employees Facility designated Administrator must maintain oversight of facility staff for proper care and supervision Make sure that this facility is following all Reporting Requirements Updating policies and procedures for resident fall risks Make sure that facility staff are always seeking timely medical attention Update and maintain Needs/Appraisal Training for all staff Maintain and train all care staff on proper documentation for the facility Communication Log There were no deficiencies observed or cited during today's case management visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 10, 2024

Type of visit: Office

A Noncompliance Conference (NCC) was conducted today on 03/01/2024, via Microsoft Teams. The purpose of the NCC was to discuss the Substantiated complaint of a violation of personal rights. Present at today’s NCC were the Regional Office Manager Stephenie Doub, Licensing Program Manager (LPM) Liza King, Licensing Program Analyst (LPA) Charlie Yang, and facility designated Administrator, Jose Ventura, Kathy Lazernik (Facility Nurse), Cindy Scheublein (Executive Director) . The administrative process was explained during this meeting and the facility designated Administrator was informed that further citations may result in Administrative Action. The focus of the concerns at this time: Facility staffing Personal Rights of the Residents Personal Rights training and verification Maintaining continued compliance Oversight of facility staff for proper care and supervision Reporting Requirements Updating policies and procedures for resident fall risks This facility and the facility designated Administrator agreed to the following: Complete and submit the LIC 500 for the most current staff, shifts, and coverage for designated shift leads Complete and submit the LIC 308 Complete and submit the LIC 309, as well as, the most updated documents from the Secretary of State filing for this corporation Complete and submit proof of most recent training in the areas of Resident Personal Rights, Resident Care, and Resident Supervision. Proof of submission to include name of trainer, topics covered with duration of training, and list of all attendees Complete and submit proof of most recent training for proper completion of the LIC 624 for all staff by 03/11/2024 Complete and submit proof of most recent training for fall prevention and updated policies and procedures for all staff by 03/11/2024 Exit Interviewthe state’s words, verbatim · CDSS document, Mar 4, 2024

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 02/29/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Jose Ventura. A brief interview was conducted with the facility designated Administrator at this time. Current census was 43 residents. The purpose of this visit was to follow up on the deficiencies that were cited from a prior visit conducted on 02/15/2024 and to follow up on the Plan of Correction. The following deficiencies were observed and cited on 02/15/2024: Residents in all residential care facilities for the elderly shall have all of the following personal rights: To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This facility did complete the Plan of Correction and provided all of the required forms and documents at this time. Plan of Correction clearance letters were printed and copies were provided to the facility designated Administrator at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Feb 29, 2024

Allegation investigated: Facility did not seek timely medical care for resident Staff did not notify resident's authorized representative of injury.

Unannounced complaint visit made out to this facility on 02/13/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Jose Ventura. A brief interview was conducted with the facility designated Administrator at this time. Current census was 43 residents. The purpose of this complaint visit was to deliver the findings from this investigation to this facility, and its representatives, in regards to the above allegations. Based on interviews conducted throughout the course of this investigation, it was learned that resident R1 sustained a fall while participating in an indoor activity. It was learned that R1 attempted to stand up during a facility supervised game and rolled R1's ankle. This fall took place on 10/17/2023. Based on a review of the forms and documents related to R1's fall that took place on 10/17/2023, several facility staff notated that R1's left ankle was swollen. These notes were observed to have been documented on 10/19/2023, 10/22/2023, 10/23/2023, 10/24/2023, and 10/25/2023. It was learned that R1 was not taken to see a licensed medical professional for an evaluation until almost 2 weeks later on 10/30/2023. Substantiated Based on interviews conducted, it was learned that this incident was not reported to the responsible parties for R1 when R1 initially sustained the fall on 10/17/2023 and was suffering with a swollen left ankle. It was learned that the responsible parties were not made aware of the incident and reason for the hospital visit until the actual date of the appointment on 10/30/2023. It was further learned that this facility, and it's representatives, admitted that there was a breakdown in communication with R1 and R1's responsible parties in connection to this fall that took place on 10/17/2023 and they should have been informed in a timely manner. As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegations were valid because the preponderance of the evidence standard had been met. The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes. Appeal rights were printed and a copy was left with the facility designated Administrator at this time. This incident is currently under review and a future civil penalty may apply based on 1569.49(f) H&S. Failure to correct the deficiencies may also result in civil penalties as well. Exit Interview Based on a review of the medical records, it was not discovered that R1 had suffered a fracture of R1's left foot until 10/30/2023 when R1 was taken to the hospital by R1's responsible party. An x-ray was performed since R1's left ankle was swollen and it was discovered that R1 had, in fact, suffered a fracture of the distal fibula in R1's left foot. Since almost two weeks had elapsed before this x-ray was performed, it was not definitive whether the initial fall on 10/17/2023 was the leading cause for the fracture since medical treatment was not sought at the time of the fall at this facility. As a result of this investigation, this Department found the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegation may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Feb 15, 2024 · control 27-AS-20231103103214

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(8) · Plan of correction due date: Feb 22, 2024

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This facility was found to be deficient as evidenced by a records review in which this facility, and it's representatives and staff, did not properly notify the responsible parties of a resident who sustained an injury posing an immediate threat to the Health, Safety, and Personal Rights of residents in care.the state’s words, verbatim · CDSS document, Feb 15, 2024

Plan of correction: The facility designated Administrator stated that all facility personnel will undergo, and complete, training on the topic of Proper Reporting Requirements for no less than (1) hour in duration. A statement of correction, along with proof of training, will be completed and submitted into CCL by the due date. Proof of training will include name of trainer, topic, and list of attendees from this facility.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Feb 22, 2024

The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This facility was found to be deficient as evidenced by a records review in which this facility, and it's representatives and staff, did not properly seek medical attention after a resident sustained an injury which posed an immediate threat to the Health, Safety, and Personal Rights of the residents in care.the state’s words, verbatim · CDSS document, Feb 15, 2024

Plan of correction: The facility designated Administrator stated that all facility personnel will undergo, and complete, training on the topic of Observation of the Resident for no less than (1) hour in duration. A statement of correction, along with proof of training, will be completed and submitted into CCL by the due date. Proof of training will include name of trainer, topic, and list of attendees from this facility.

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 02/15/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Jose Ventura. A brief interview was conducted with the facility designated Administrator at this time. Current census was 43 residents. The purpose of this visit was to follow up on the deficiencies that were cited from a prior visit conducted on 01/29/2024 and to follow up on the Plan of Correction. The following deficiencies were observed and cited on 01/29/2024: All individuals shall be residential care facility for the elderly certificate holders prior to being employed as an administrator. (1) Applicants who possess a valid Nursing Home Administrator license, issued by the California Department of Public Health, shall be exempt from completing an approved Initial Certification Training Program and taking a written exam, provided the individual completes twelve (12) hours of classroom instruction in the following Core of Knowledge areas: (A) Four (4) hours of instruction in laws, regulations, policies, and procedural standards that impact the operations of residential care facilities for the elderly, including but not limited to the authority referenced in this Chapter. Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This facility did complete the Plan of Correction and provided all of the required forms and documents at this time. Plan of Correction clearance letters were printed and copies were provided to the facility designated Administrator at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Feb 15, 2024

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 01/29/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Jose Ventura, who was briefly interviewed. It was learned that there were residents under the care of hospice at this time while other residents were receiving services through home health as well. This facility does have a hospice waiver approved for (5) residents and program on file for dementia care unto the residents at any given time. Current census was 43 residents, of which, 27 were in the Assisted Living building (Building A). The other 16 residents, of which (8) were living in Building B and another (8) in Building C were considered as Memory Care. A tour of this facility was conducted alongside the facility designated Administrator Jose Ventura. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Jose Ventura. Kitchen area was toured. Cabinets and drawers were reviewed. Food preparation stations, dishwashing station, and other areas intended for meal preps were toured. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe additional food storage units which were present and functional at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication rooms, located in each building, were reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications were discussed with the facility designated medication technicians at this time. The medication carts were observed to be locked and made inaccessible to the residents at this time. A tour of the resident bedrooms and restroom was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. It was learned that there were only private and semi-private living arrangements for residents on the Assisted Living portion of this facility. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Linen closet, located in the facility laundry area, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. A tour of the Memory Care buildings, Building B and C, was conducted. Fire extinguishers, located throughout this facility, were observed to have been annually inspected on 05/05/2023 by the local fire extinguisher company, Cisco Fire Sprinklers Inc., and in compliance at this time. First aid kits were observed to be present and contained all of the required components at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gates, and exits was conducted. A review of (7) facility resident files was conducted. A review of (7) facility personnel files was conducted. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 29, 2024

Type of visit: Case Management - Other

Unannounced case management visit made out to this facility on 01/29/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Jose Ventura, who was briefly interviewed. It was learned that there were residents under the care of hospice at this time while other residents were receiving services through home health as well. This facility does have a hospice waiver approved for (5) residents and program on file for dementia care unto the residents at any given time. Current census was 43 residents, of which, 27 were in the Assisted Living building (Building A). The other 16 residents, of which (8) were living in Building B and another (8) in Building C were considered as Memory Care. The purpose of this case management visit was to discuss the recent submission of Special Incident Reports (SIR) into CCL that were reviewed by this LPA. This discussion was held with the facility designated Administrator Jose Ventura at this time. It was learned that policies and procedures were put into place to address the issues from the SIRs. It was learned that certain staff were re-trained while other staff were subject to disciplinarian action after an investigation was completed. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 29, 2024