Better Living Care Home

Type of visit: Case Management - Other

On 07/16/2026 at 10:30 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit regarding the facility's request for a capacity increase. LPA met with Caregiver Liza Sanchez and explained the purpose of the visit. Ms. Sanchez contacted the Licensee/Administrator, Anabelle Galera, by telephone to inform her of the visit. Ms. Galera authorized Ms. Sanchez to sign the report on her behalf in her absence. LPA toured the facility to verify the floor plan for the requested capacity increase to 10 residents. LPA observed eight (8) resident bedrooms located on the first floor and three (3) staff bedrooms located on the second floor. Resident bedrooms and common living areas were furnished appropriately and in good repair. Bathrooms were equipped with grab bars and non-skid mats. Adequate lighting was observed throughout the facility.The hot water temperature measured 110.5 degrees Fahrenheit. The first-aid kit was complete. Smoke detectors and carbon monoxide detectors were tested and found to be operational. The fire extinguisher was last serviced on 10/17/2025. A locked cabinet was available for the centralized storage of medications. No deficiencies or concerns were observed during today's inspection. Based on today's observations, the facility appears to be prepared for the requested capacity increase to 10 residents, including the proposed accommodations for bedridden residents, consistent with the approved facility sketch. An exit interview was conducted, and a copy of this report was provided to the facility representative.the state’s words, verbatim · CDSS document, Jul 16, 2026

Type of visit: Case Management - Deficiencies

On 06/03/2026 at 5:30 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit. LPA met with, caregiver, Lilybeth Nagata, and explained the purpose of the visit. Lilybeth phoned the Administrator, Anabelle Galera to inform. Rudy and Anabelle arrived approx. 1 hour later. On 03/24/2026 LPA conducted a complaint (#15-AS-20250813090813) visit where deficiencies were cited. The Plan of Correction (POC) due date was 04/21/2026. POC was not received. LPA is re-citing the deficiencies. CCR 87463(a) CCR 87611(b)(1) CCR 87465(a)(5) CCR 87465(a)(1) Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of this report, LIC421FC and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 3, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: Jun 5, 2026

87463 – Reappraisals Section (a) The licensee shall ensure that each resident is reappraised as necessary to determine whether the facility continues to meet the resident’s needs. This requirement is not met as evidenced by: Based on interviews and record review, the licensee failed to ensure staff met the care and supervision needs of Resident (R1). Facility records indicated blood pressure monitoring was required; however, documentation did not demonstrate that staff monitored or recorded the resident’s blood pressure as required. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 3, 2026

Plan of correction: Administrator agreed to read the regulation and self certify understanding moving forward. Will send self-certification to CCLD by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87611(b)(1) · Plan of correction due date: Jun 5, 2026

87611 General Requirements for Allowable Health Conditions (b) The licensee shall complete and maintain a current, written record of care for each resident that includes, but is not limited to, the following: (1) Documentation from the physician of the following: This requirement is not met as evidenced by: Based on interviews and record review, the licensee failed to ensure complete and maintain written records of care including but not limited to documentation from physician for R1. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 3, 2026

Plan of correction: Administrator agreed to read the regulation and self certify understanding moving forward. Will send self-certification to CCLD by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(5) · Plan of correction due date: Jun 5, 2026

87465 – Incidental Medical and Dental Care Section (a)(5) The licensee shall be responsible for ensuring that medications are given according to physician's directions. This requirement is not met as evidenced by: Based on record review and interviews, the licensee failed to ensure medications were administered and documented according to physician directions for Resident (R1). Review of R1’s medication administration records revealed medications listed in hospital records were not documented on the facility’s MAR and dosage discrepancies were noted. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 3, 2026

Plan of correction: Administrator agreed to read the regulation and self certify understanding moving forward. Will send self-certification to CCLD by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(a)(1) · Plan of correction due date: Jun 5, 2026

87465(a)(1) Incidental Medical and Dental Care -The licensee shall ensure residents receive necessary medical care and assistance with medical needs. This requirement is not met as evidenced by: Based on record review and interviews, the licensee failed to ensure medications were administered and documented according to physician directions for Resident (R1). Review of R1’s medication administration records revealed medications listed in hospital records were not documented on the facility’s MAR and dosage discrepancies were noted. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 3, 2026

Plan of correction: Administrator agreed to read the regulation and self certify understanding moving forward. Will send self-certification to CCLD by POC due date.

Type of visit: Required - 1 Year

On 03/24/2026 at 1:00 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Liza Sanchez and explained the purpose of the visit. Ms. Sanchez phoned the Licensee/Administrator, Anabelle Galera to inform. Anabelle Galera arrived approximately 1 hour later. The facility’s fire clearance was approved for capacity of eight (8) residents. In which all eight (8) resident may be non-ambulatory. Administrator certificate # 7003997740 expires 02/24/2028. LPA toured facility with Anabelle including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of eight (8) total bedrooms which all bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 77 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 107 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. LIC809-C Continued... LIC809-C (Page 2) Smoke and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 10/17/2025. Emergency Disaster Plan was last posted on 02/12/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 12/12/2025. LPA reviewed seven (7) residents records. LPA reviewed six (6) staff records and all of the staff have current first aid training and associated to the facility. LPA reviewed a sample of resident’s medications and all medications and doctor's orders were compliant. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/31/2026: LIC 308 Designation of Administrative Responsibility - Reviewed LIC 309 Administrative Organization - Reviewed Updated LIC 500 Personnel Report LIC 610E Emergency Disaster Plan - Reviewed Liability Insurance - Reviewed Current Administrator’s Certificate - Reviewed No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 24, 2026

Type of visit: POC

On 04/25/2025 at 9:00 AM Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Plan of Correction (POC) visit and met with Caregiver, Liza Sanchez. LPA explained the purpose of the visit to Liza. Liza phoned the Licensee/Administrator, Rudy Galera, to inform. LPA spoke with Licensee to explain the purpose of the visit. Anabelle Galera arrived shortly. Rudy Galera arrived approximately 10:00 AM. LPA conducted an complaint visit on 04/03/2025 and cited for substantiated allegations. The POC due date for cited deficiencies were 04/17/2025. LPA did not receive all the trainings for all of staff. Administrator only sent partial training logs for four (4) of the seven (7) staff. LPA will grant additional time for the staff to complete the In-Service Trainings and new POC due date is May 15th, 2025. No citations are being issued on this date. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 25, 2025

Type of visit: Case Management - Other

On 04/25/2025 at 10:30 am Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit. LPA met License/Administrator, Anabelle Galera and explained the purpose of the visit. While LPA L. Alexander was conducting a Plan of Correction visit on 04/25/2025. LPA observed renovations being done in one of the resident's bedroom and hallway. Community Care Licensing (CCLD) was not notified of the renovation project. Licensee/Administrator, Anabelle Galera, stated that the project started on 04/24/2025 and that it should be complete today. LPA observed construction with the flooring in a vacant bedroom and hallway that leads to the bedroom. Anabelle stated that a fire door was being installed as well. LPA observed the residents were not being impacted from the construction project and were safe from any hazard. LPA advised Anabelle to send a notification to Licensing stating what the remodeling project is, duration time, and how they plan to keep the residents safe and undisturbed during any future remodeling projects. No citations are being issued on this date. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 25, 2025

Type of visit: Required - 1 Year

On 4/25/2025, at 1:30 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct the Required Annual Inspection of the facility. Upon arrival, LPA stated the purpose of the visit to Administrators / Licensees Anabelle and Rudy Galera. The LPA toured the interior and exterior of the facility, inspecting the kitchen, dining area, restrooms, community living spaces, bathrooms, resident rooms, and the grounds of the facility. More than the required minimum of 7 days of nonperishable and 2 days of perishable foods were appropriately stored. The maximum hot water temperature was 107.8 degrees Fahrenheit and the living room temperature was 68.3 degrees Fahrenheit. The carbon monoxide and smoke detectors were fully operational. The fire extinguisher was fully charged and last replaced on 10/3/2024. The LPA observed postings in the facility that included a complaint poster, Ombudsman and Personal Rights posters, Theft and Loss Policy, Rights to Resident Council, and Rights to Family Council. An administrator is on site more than the minimum of 20 hours a week to oversee the proper business operations. The LPA reviewed facility records, records of 5 staff members, and records of 5 residents. No citations were issued during the inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 25, 2025

Allegation investigated: Staff did not follow medical professional's prescribed orders Staff isolated resident in care

On 04/03/2025 at 2:35 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Caregiver, Liza Sanchez to deliver the findings of above allegations. LPA explained the purpose of the visit with Liza Sanchez. Liza Sanchez phoned the Licensee/Administrator, Anabelle Galera to inform. Anabelle Galera was unavailable to come to the facility. Anabelle authorized Liza Sanchez to sign the document. During the investigation, the Department obtained the following documents from the facility – personnel record, residents’ roster, admission agreement, physicians report, needs & services plans, Physicians orders, narrative charting, medication worksheets. The Department interviewed W1, S1, S2, S3, and S4. LIC9099-C Continued... Substantiated LIC9099-C (Page 2) Allegation: Staff did not follow medical professional's prescribed orders Investigation Finding: Substantiated On 11/14/2024, the Department interviewed S1. S1 stated that R1 continually removed the medically ordered CPAP mask. The Department reviewed Medical Administration Records (MAR) from 01/2023 thru 03/2023 with prescribed medication orders (John Muir) from 10/27/2022 and observed not to be administered consistently. R1 was prescribed continuous positive airway pressure (CPAP) for obstructive sleep apnea in 2019. Doctor’s order prescribes to wear CPAP mask nightly and utilize distilled water. Records (ResMed) shows that no data was available during the months of Dec 2022-Jan 2023 which indicates CPAP machine was not in use. Further review of MAR and medication orders (10/27/22) there was no use of ketoconazole 2% shampoo for scalp, donepezil 23mg Tab was not administered according to February ’23 MAR and latanoprost .005% for glaucoma was not administered according to March ’23 MAR. Allegation: Staff isolated resident in care Investigation Finding: Substantiated On 10/11/20204 the Department interviewed W1. W1 stated that the staff isolated R1 to their room W1 stated that R1 developed a dementia related behavior of spitting inside. W1 stated that R1 was isolated and sat in her room alone all day, R1 ate her meals alone. On 10/03/2024 the Department interviewed S2 and S3. S2 stated that R1 wasn't isolated. R1 would stay in their room the first year because daughter brought DVD's and R1 would watch movies. LIC9099-C Continued... LIC9099-C (Page 3) S2 stated "we always gave R1 water. Sometimes R1 would refuse...daughter brought a lot of drinks. S2 stated, "we would give R1 cranberry juice, give R1 drink, like 8oz, sometimes R1 would have 3 glasses of 8oz. S2 stated that most of the time, R1 would be in TV room or their room. R1 would be in their room watching movie, iPad and R1's daughter would call her on her iPad. S3 stated that most of the time, R1 would be in TV room or their room. On 11/14/20204, the Department interviewed S1. S1 stated that R1 started spitting in 2022. There was a speech evaluation with John Muir Medical. When R1 would start spitting she would go back to her room. S1 stated, "...not fair for other residents when R1 spit food out and in front of other residents. R1 started spitting at clients/staff, spit over the walls, spitting food and saliva. S1 stated that R1 was kept in the room, then come out to eat meals, whereby R1 was placed at a table behind wall on the other side of wall. Based on the Departments observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations Staff did not follow medical professional's prescribed orders and Staff isolated resident in care are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted. A copy of this report and appeal rights provided LIC9099-C (Page 7) Allegation: Resident sustained multiple ulcer wounds while in care Investigation Finding: Unsubstantiated It was alleged that R1 developed ulcer wounds in October 2020 at the right posterior foot and at the left foot. Review of documents indicate that on 10/8/2020 the facility was informed by W1 that R1 had developed blisters. Staff stated that no blisters had been observed. R1 was transferred to hospital for evaluation on 10/13/2020, however, the wounds were not staged. R1 was referred to a Foot and Podiatry specialist who indicated that the right posterior foot had a blister measuring 5 cm in diameter, and the left foot had a full thickness wound measuring 5 cm in diameter. The Specialist indicated that the wounds were Stage 2, not at prohibited stages of 3, 4, or Unstageable. On 10/15/2020, Home Health began for wound treatment at the home without issue. The Department obtained and reviewed the medical documents, which did not provide information to indicate when the wounds may have started to develop nor that they developed due to staff not performing a specific need. No information emerged that there was further concern for wounds until March of 2023. Per records review and Staff interviews, R1 was taken out for several hours by a private companion on what staff believed were extended car rides; on 2/14/2023 for approximately 4.5 hours; 2/21/2023 for approximately for approximately 4.5 hours; and on 2/24/2023 staff observed a 1.25 cm x 1.25 cm blister at the buttocks. Records indicate that W1 was informed, and that Staff continued to turn R1 every 2 hours and applied cream (started in 1/2022). On 2/24/2023 staff requested W1 to purchase an air mattress, which the facility purchased on 2/27/2023 after W1 refused. On 2/25/2023, records indicated that R1 was again taken on an outing 2/25/2023 for approximately 5.5 hours. On 2/26/25 staff observed that the blister had popped and another area was beginning to be irritated. LIC9099-C Continued... LIC9099-C (Page 8) R1 was medically evaluated on 2/28/2023. Home Health was started on 3/2/2/2023. On 3/8/2023 Home Health documented that the wounds had reduced, however, on 3/10/2023 Home Health arranged for R1 to be taken to wound care clinic for evaluation by W1, but no information was provided to the facility. On 3/13/2023 Home Health came to the home and noted R1’s wounds had reduced, however, on 3/15/2023 the facility was informed by the clinic that R1 should return as the injuries were now determined to be at Stage 3. W1 denied that R1 had been on outings that involved long periods of sitting in a car. No information emerged to corroborate what took place during those times. Allegation: Staff did not seek timely medical care for resident Investigation Finding: Unsubstantiated The Department found that in October of 2020 R1 had developed blisters at the right posterior foot and at the left foot. Review of documents indicate that on 10/8/2020 the facility was informed by W1 that R1 had developed blisters not observed by staff. R1 was transferred to hospital for evaluation on 10/13/2020, and to a Foot and Podiatry specialist who indicated that the right posterior foot had a blister measuring 5 cm in diameter, and the left foot had a full thickness wound measuring 5 cm in diameter. The Specialist indicated that the wounds were Stage 2, not at prohibited stages of 3, 4, or Unstageable. On 10/15/2020, Home Health began for wound treatment at the home without issue. Therefore, the Department is not able to determine that the facility did not seek immediately necessary medical care in a timely manner. LIC9099-C Continued... LIC9099-C (Page 9) The Department found that per records review and Staff interviews for 2023, R1 was taken out for several hours by a private companion on what staff believed were extended car rides; on 2/14/2023 for approximately 4.5 hours; 2/21/2023 for approximately for approximately 4.5 hours; and on 2/24/23 staff observed a 1.25 cm x 1.25 cm blister at the buttocks. Records indicate that W1 was informed, and that Staff continued to turn R1 every 2 hours and applied cream (started in 1/2022). On 2/25/2023, records indicated that R1 was again taken on an outing 2/25/2023 for approximately 5.5 hours. On 2/26/2023 staff observed that the blister had popped, and another area was beginning to be irritated. R1 was medically evaluated on 2/28/2023. Home Health was started on 3/2/2/2023. On 3/8/2023 Home Health documented that the wounds had reduced, however, on 3/10/2023 Home Health arranged for R1 to be taken to wound care clinic for evaluation by W1, but no information was provided to the facility. On 3/13/2023 Home Health came to the home and noted R1’s wounds had reduced, however, on 3/15/2023 the facility was informed by the clinic that R1 should return as the injuries were now determined to be at Stage 3. Therefore, the Department is not able to determine that the facility did not seek medical care in a timely manner. Allegation: Staff did not assist resident with proper hygiene needs Investigation Finding: Unsubstantiated On 10/11/2024 the Department interviewed W1. W1stated that R1 had an estimated five (5) Urinary Tract Infections (UTIs) in 2020 and that they have not found any documentation of the UTIs in their records nor proper administration of the ordered antibiotics. LIC9099-C Continued... LIC9099-C (Page 10) On 10/03/2024, the Department interviewed S2, S3 and S4. S2 stated that they would change R1's diaper in the mornings, lunch and dinner. S3 stated that they changed R1's diapers and that R1 needed 2 people to assist. S3 further stated that they checked R1's diaper 3-4 times a day. Checked R1 diaper after breakfast and change R1's diaper at night. S4 stated that R1 could not stand up good. But they would change R1's diaper at night every 2hrs. On 11/13/2024, the Department interviewed S1. S1 stated that Staff check all clients at night, and that Caregiver would take R1 to the bathroom every 2-3 hours. On 10/03/2023, the Department interviewed S1 who stated that staff would change R1s clothes every day and that they would change R1's diaper in the mornings, lunch and dinner. S2 stated that R1's diapers were changed and that R1 needed 2 people to assist. S2 stated that they checked R1's diaper 3-4 times a day, checked R1s diaper after breakfast and change R1's diaper at night. No information emerged to contradict the facility. Allegation: Staff did not ensure resident was hydrated Investigation Finding: Unsubstantiated On 10/03/2024, the Department interviewed S2, S3 and S4. S2 stated that they would give R1 water and juice 4x's a day with breakfast, lunch, dinner and in between. S3 stated "we always gave R1 water. Sometimes R1 would refuse...daughter brought a lot of drinks. S3 stated, "we would give R1 cranberry juice, give R1 drink, like 8oz, sometimes R1 would have 3 glasses of 8oz. LIC9099-C Continued... LIC9099-C (Page 11) Allegation: Staff did not ensure resident was nourished Investigation Finding: Unsubstantiated On 10/03/2024 S1 stated that last year (2023) R1 was not eating much. S1 stated, "We told the family that R1 would spit the food out and she was spitting food and saliva." S2 stated that R1's eating was 100%, it depended on R1. Sometimes R1 would spit and sometimes R1 would swallow, and we told the daughter. S2 stated that R1 ate vegetables, bread, protein, meat and fish. On 11/14/2024 and 12/23/2024 S2 stated that R1’s daughters would order snacks and have it delivered via e.g., soda, chips. R1 would eat chicken wings with BBQ sauce and eat anything sweet. ate well until March of 2023. The Department obtained medical records which did not indicate that R1 was malnourished. Allegation: Staff did not change resident's clothing Investigation Finding: Unsubstantiated On 10/03/2024, S2 stated that they would change R1’s clothes every day. S3 stated that R1's daughter would buy clothes online and send clothes for R1 to wear. W1 wanted R1 to feel comfortable. On 12/23/24 S1 stated that R1 wore house top/bottoms and wore pajamas. No information emerged to contradict the facility. LIC9099-C Continued... LIC9099-C (Page 12) Based on records review, interviews conducted, and observations made, the Department has investigated the above allegations of Resident sustained multiple ulcer wounds while in care, Staff did not seek timely medical care for resident, Staff did not assist resident with proper hygiene needs, Staff did not ensure resident was hydrated, Staff did not ensure resident was nourished and Staff did not change resident's clothing and found it to be unsubstantiated. A finding that the complaint allegation is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegations above are Unsubstantiated. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 3, 2025 · control 15-AS-20230629095623

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(d) · Plan of correction due date: Apr 17, 2025

87465 Incidental Medical and Dental Care (d)If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided all of the following requirements are met: This requirement is not met as evidence by: Based on observations, interviews and record reviews, the licensee did not comply with the section cited above in by not following R1’s doctor’s orders with administering prescribed medication orders including but not limited to daily use with a CPAP machine and CPAP mask during sleep, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 3, 2025

Plan of correction: Administrator will read the regulation and self-certify understanding and will comply. In addition, conduct In-Service training with all staff on following doctor's orders including but not limited to CPAP machines/masks. Administrator will submit self-certification, training topic and synopsis of material covered and staff training sign-in sheet to CCLD by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Apr 17, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement is not met as evidence by: Based on observations, interviews and record reviews, the licensee did not comply with the section cited above in by isolating R1 from other residents during meals, watching television which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 3, 2025

Plan of correction: Administrator will read the regulation and self-certify understanding and will comply. In addition, conduct In-Service training with all staff on resident personal rights including but not limited to CPAP machines/masks. Administrator will submit self-certification, training topic and synopsis of material covered and staff training sign-in sheet to CCLD by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(b)(1)(A)(B) · Plan of correction due date: Apr 17, 2025

87705 Care of Persons with Dementia (b) Licensees shall be responsible for the following: (1) Ensuring staff receive the following training as part of the training requirements specified in Section 87208 Plan of Operation: (A) Dementia care, including, but not limited to, knowledge about hydration, nutrition, skin care, communication, therapeutic activities, behavioral challenges, the environment, and assisting with activities of daily living; (B) Recognizing symptoms that may create or aggravate behavioral expression, as defined in Section 87101, Definitions, including, but not limited to, dehydration, urinary tract infections, and problems with swallowing; and This requirement is not met as evidence by: Based on observations, interviews and record reviews, the licensee did not comply with the section cited above in by providing to R1, the "Care of persons with Dementia", by recognizing symptoms that may create or aggravate behavioral expression, including, but not limited to, dehydration, urinary tract infections, and problems with swallowing; and spitting which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 3, 2025

Plan of correction: Administrator will read the regulation and self-certify understanding and will comply. In addition, conduct In-Service training with all staff on Dementia Care including but not limited to behavioral expression. Administrator will submit self-certification, training topic and synopsis of material covered and staff training sign-in sheet to CCLD by POC due date.

Type of visit: Case Management - Other

On 12/23/2024 at 2:30 PM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit. LPA met with Caregiver, Leonilla "Leoni" Montealto, and explained the purpose of the visit. Leoni phoned Licensee/Administrator, Rudy & Anabelle Galera to inform. Anabelle Galera authorized, Caregiver Liza Sanchez, to sign document report. While LPA L. Alexander was conducting a complaint investigation (15-AS-20230629095623) on 12/23/2024. During record review LPA observed R1's file did not include annual medical assessments and appraisals. The appraisals reviewed were from 07/26/2019 and 01/12/2022. LPA observed the facility's Internal Incident Report, dated 10/08/2020, that R1 developed blisters all over their body. In addition, LPA observed during record review that there were no home health records available for R1. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights providedthe state’s words, verbatim · CDSS document, Dec 23, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(6) · Plan of correction due date: Jan 7, 2025

(c) Licensees who accept and retain residents with dementia...(6) Appraisals are conducted on an ongoing basis pursuant to Section 87463, Reappraisals. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in by not updating annual medical assessments and Appraisal Needs and Services Plans (ANS) for R1 who developed blisters and was noted by Administrator on 10/08/20 while in care which posed a health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 23, 2024

Plan of correction: Administrator will read the regulation and self-certify that they read and understand this regulation moving forward and will comply by submitting self-certification to CCLD by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87609(b)(4) · Plan of correction due date: Jan 7, 2025

87609 Allowable Health Conditions and the Use of Home Health Agencies (b) Incidental medical care may be provided to residents through a licensed home health agency...(4) The licensee and home health agency agree in writing on the responsibilities... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in by not having home health records on file for R1 while in care which posed a health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 23, 2024

Plan of correction: Administrator will read the regulation and self-certify that they read and understand this regulation moving forward and will comply by submitting self-certification to CCLD by POC due date.

Type of visit: Required - 1 Year

On 04/30/2024 at 1:15 PM, Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregivers, Caysha Meltel and Montealto Nemsio and explained the purpose of the visit. Caysha phoned the Licensee/Administrator, Anabelle Galera to inform. Licensee/Administrator, Rudy Galera arrived shortly. Licensee/Administrator, Anabelle arrived approx. an hour later. The facility’s fire clearance was approved for eight (8) residents in which all may be non-ambulatory. Hospice waiver approved for four (4) residents. Administrator's Certificate #6014138740 and 6014136740 expired 02/23/24 and 02/24/24 but are currently being renewed. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 11 total bedrooms which 8 bedrooms are occupied by the residents and 3 bedrooms is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathrooms was measured at 104.5 and 109.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. LIC809-C Continued... LIC809-C Continued... Smoke and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 10/03/23. Emergency Disaster Plan was last posted on 09/23. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 01/25/24. LPA reviewed 8 residents records. LPA reviewed 6 staff records and 6 of 6 have current first aid training and associated to the facility. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 05/07/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 30, 2024

The state marks this report as 8 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.