Braswells Yucaipa Leisure Manor

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) E. Conchas conducted an unannounced visit to inquire about the facility SOC 341 self-report incident that was reported on 08/07/2026 involving client on client altercation. LPA met with Administrator Linda Woofter and explained the purpose of visit. During today's visit, LPA spoke with Administrator to discuss the incident concerns and conducted a Health and safety wellness check on both residents. LPA spoke with Linda about the incident and surrounding events, collected documentation pertaining to the incident. LPA interviewed both residents at the facility during visit. LPA observed no imminent health or safety concerns at the time. No deficiency was cited during this visit. An exit interview was conducted where this report was discussed and provided to Administrator Linda Woofter.the state’s words, verbatim · CDSS document, Aug 17, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) E. Conchas conducted an unannounced visit to inquire on the facility self-report incident that was reported on 08/06/2026 involving personal rights to a resident. LPA met with Administrator Linda Woofter and explained the purpose of visit. During today's visit, LPA spoke with Administrator to discuss Resident 1 (R1) personal rights concerns and conducted a Health and safety wellness check on R1. LPA spoke with Linda about the incident and surrounding events, conducted a tour of R1 living quarters and collected documentation pertaining to the incident. LPA attempted to interview R1, however, R1 was not at the facility during the visit. LPA observed no imminent health or safety concerns at the time. No deficiency was cited during this visit. An exit interview was conducted where this report was discussed and provided to Administrator Linda Woofter.the state’s words, verbatim · CDSS document, Aug 17, 2026

Type of visit: Case Management - Other

LPA E. Conchas conducted an unannounced case management visit regarding complaint number 56-AS-20260807162134. LPA met with Administrator, Linda Woofter and explained the purpose of the visit. LPA conducted a tour of the Pine Cottage facility and observed the following and a citation was issued. LPA observed room 5 have one of the residents bed partially blocking the the door way exit including a wheelchair, night stand and other miscellaneous items . An exit interview was conducted with Administrator - Linda Woofter and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 11, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(a) · Plan of correction due date: Aug 12, 2026

87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy... This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having client 1's bed, wheelchair and night stand blocking the exit door of bedroom 5 which poses a potential health, safety and or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 11, 2026

Plan of correction: Administrator has agreed to do an all staff inservice training and read over the entire regulations, remove all equiptment from the exit way of room 5 to ensure emergency exits are clear of obstruction. Licensee will provide pictures and the completed sign in staff training sheet via email to LPA by POC date.

Allegation investigated: Facility staff did not provide adequate supervision, resulting in a resident eloping from the facility.

On 7/2/2026 Licensing Program Analysts (LPA) Edith Conchas made an unannounced visit to the facility to deliver the findings of the above allegation. LPA explained the purpose of the visit to the MedTech supervisor, Krystal Tarango. The investigation consisted of file review, interviews and observation. Allegation Facility staff did not provide adequate supervision, resulting in a resident eloping from the facility. Interview with staff and witnesses reveal the resident eloped from the doctors office. Interviews with witness 3 (W3) revealed that Resident 1 (R1) had multiple medical appointments and was scheduled for pickup at approximately 1:30 p.m. Interviews with w1, w2, and w3 indicated that although the outside agency provides escorts for clients who require one, R1 was not identified (flagged) as needing an escort in the initial assessment when R1 was established with InnovAge. Witness 2 stated that R1 left the clinic at approximately 11:45 a.m. Witness 3 reported that the driver arrived at the clinic at around 1:30 p.m. to pick up R1, at which time the driver informed InnovAge staff that R1 was not present. Continue to LIC9099 Unsubstantiated Facility staff reported they do not arrange or manage escort services for residents that are on InnovAge insurance. Witness 2 reported that this was R1’s first appointment outside the InnovAge facility. Staff 2 (S2) stated that residents often return from outside appointments at varied times which is why they did not suspect the R1 was gone. Staff 1 and S2 reported they were not notified that R1 was missing until they were contacted by R1’s daughter around 3:30 PM.. During the investigation, LPA did not find evidence to corroborate the allegations due to R1 was not under the care of the facility during the time of the incident. Based on the evidence, the allegation mentioned above is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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 at this time. An exit interview was conducted where this report was discussed and provided to MedTech Supervisor Krystal Torango.the state’s words, verbatim · CDSS document, Jul 2, 2026 · control 56-AS-20260624102926

Allegation investigated: Facility retained resident who requires a higher level of care.

Licensing Program Analysts (LPAs) Andrew Martinez and Edith Conchas made an unannounced visit to the facility for the purpose of completing an investigation into the above complaint allegation. LPAs met with Administrator Linda Woofter and explained the reason for the visit. Today’s visit consisted of staff interviews and records review. R1 is no longer a resident of the facility and was unable to be interviewed. For the allegation: Facility retained resident who requires a higher level of care. Based on LPA’s records review, records revealed R1 was admitted to the facility following the required evaluation of the resident's Medical Assessment for Residential Care Facilities for the Elderly (LIC 602A) and Preplacement Appraisal Information (LIC 603), which had indicated that the facility could appropriately address the resident's care needs. LPA observed R1’s post acute treatment center records that also did not reveal R1 required a higher level of care needed per the transfer/discharge reports. Based on interview conducted with the facility Administrator, the information documented in R1's LIC 602A and LIC 603, that were completed prior to R1s admission to the facility, they did not indicate a need for a higher level of care. Unsubstantiated *** Continued from LIC 9099 *** As a result, the facility determined that it could meet R1's care needs and admitted R1 for residency. Administrator reported that R1’s behavior had abruptly changed within days after the resident was admitted to facility. Records revealed R1 was admitted to the hospital on or around February 7, 2026, for psychiatric evaluation and never returned to the facility. Based on interviews and records review, this allegation is UNSUBSTANTIATED. During the investigation, LPA did not find evidence to corroborate the allegations. Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. An exit interview was conducted where this Complaint Investigation Report (LIC 9099, LIC 9099-C) was discussed and copy provided to Administrator Linda Woofter.the state’s words, verbatim · CDSS document, Jun 2, 2026 · control 56-AS-20260209213256

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) E. Conchas and A. Martinez made an unannounced visit to the facility to conduct a required annual inspection. LPA's met with Administrator Linda Woofter and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (61). LPAs conducted an overall inspection of the facility. The indoor and outdoor passageways are free of obstruction. The facility has sufficient lighting and is maintained at a comfortable temperature. The facility has sufficient indoor and outdoor space for resident activities. The facility is equipped with operating smoke detectors/carbon monoxide alarms, working laundry equipment, and telephone service. Resident’s showers, toilets, and hand-washing areas were operating properly. The hot water temperature in resident bathrooms measured between 105. and 107.7 degrees. LPA observed that the client bedrooms were appropriately furnished with the required furniture, lighting and space. LPA observed the restrooms to be functional, equipped with the required grab bars and nonslip mats. The facility has posted in a common area, facility license, personal rights, facility sketch, emergency disaster plan and telephone numbers, and CCLD complaint poster. LPA did not observe an infection control plan however did observe OSHA training guidelines. The facility has completed their fire extinguisher inspection service dated May 14, 2026. The facility’s annual fire sprinkler inspection was completed on 1/5/2026 by DC Electronics Inc. Facility liability insurance was observed and expires on 10/1/2026. LPA observed the facility’s P&I surety bond to be current with an expiration date of 10/30/2028. Emergency disaster plan was last reviewed in March 2026. Continue to LIC809C Facility kitchen and dining area are maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care. Facility orders food twice a week. Sharps and chemicals were kept locked and inaccessible to residents in care. Emergency food and water supply was observed. Facility has 24-hour/7days a week care staff. Facility staff have current CPR/first aid training and criminal record clearances and/or exemptions on file. Resident’s medications are labeled and centrally stored in locked medication carts. Staff files reviewed were observed to be complete. Resident files were reviewed and observed to be complete. Facility’s last disaster drill was conducted on 5/21/2026. The following are violations observed and technical advisories were issued. · LPA observed several rooms to be unclean, unsanitary and in disrepair. Observation of R4’s room revealed the closet door was partially detached from closet door track. · R2 restroom floor and bathtub appeared dusty and stained. R3 restroom had a very strong unpleasant odor. · LPA observed the CCL poster does not meet correct poster size per regulation. · Facility informed LPA of recent change of pharmacist and has not completed medication audits. Facility was informed of required audits to be conducted twice a year. Based on observations and record review four (4) technical violations were issued per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, where this Facility Evaluation Report and Technical Violations (LIC 809s and LIC 9102s) were discussed and copies provided to Administrator Linda Woofter.the state’s words, verbatim · CDSS document, Jun 2, 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: Resident developed pressure injuries. Staff left resident on floor for an extended period of time.

Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Administrator Linda Woofter and explained the purpose of the visit regarding the allegations stated above. First allegation: Resident developed pressure injuries. Regarding the allegation stated above, LPA conducted interviews with Staff #1, Staff #2, and Staff #3, regarding the alleged allegation and Staff #1-3 informed LPA that Resident #1 was ambulatory and overall physical status was good. Staff #1-3 further informed LPA that Resident #1 did not have bowel or bladder impairment and resident was fully capable of handling their own toileting needs. In addition, Staff #1-3 further explained that while Resident #1 was at the facility no pressure injuries were witnessed or reported. In addition, Staff #1-3 also indicated that Resident #1 was not receiving wound treatment. Unsubstantiated LPA conducted a record review pertaining to Resident #1 during the review of records LPA discovered that Resident #1 was ambulatory and did not have any skin conditions. In addition, during the review of records LPA observed no records or reports stating that Resident #1 sustained pressure injuries. Second allegation: Staff left resident on floor for an extended period of time. Regarding the allegation stated above, LPA conducted an interview with Resident #2 regarding the alleged allegation and Resident #2 informed LPA of being a witness when Resident #1 was lying on the bed and fell to the floor. Resident #2 informed LPA that resident waited for a while and then informed staff that Resident #1 was on the floor. Resident #2 informed LPA that staff immediately responded to Resident #1 and contacted 911. Resident #2 could not confirm the time that Resident #1 was on the floor but indicated that it was daytime. LPA conducted interviews with Staff #1-3 and all denied the alleged allegation and indicated that on 1/18/2025 at approximately 1:20PM Resident#2 informed staff that Resident #1 was on the floor unresponsive. Furthermore, Staff #1-3 informed LPA that Fire Department was contacted and transported Resident #1 to local hospital to be treated. Staff #1-3 informed LPA that on 1/21/2025 it was confirmed that Resident #1 had suffered a stroke. Based on corroborating evidence LPA has determined that the above allegations are Unsubstantiated, meaning that 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. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Linda Woofter.the state’s words, verbatim · CDSS document, May 22, 2026 · control 56-AS-20250122090224

Allegation investigated: Resident sustained rashes while in care

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to deliver complaint investigation findings. After introducing herself, LPA met Administrator, Linda Woofter, to discuss the findings. On September 09, 2022, the Department received a complaint on the above allegation pertaining to resident #1 (R1). The Department’s investigation consisted of review of facility and other records, observations, and interviews with pertinent individuals. Regarding the allegation, resident sustained rashes while in care, it was alleged that on 8/14/2022 R1 was observed with rashes on their body. On 8/14/2022, R1 was medically assessed with end stage dementia, L1 compression fracture, L intertrochanteric hip fracture, and skin tears of bilateral elbows. On the same day, an integumentary/skin assessment was also conducted and R1 was found to have no lesions, irritations, or redness. Unsubstantiated Due to conflicting information received, it could not be determined that facility staff neglected R1 resulting in R1 sustaining rashes while in care, therefore, the allegation is Unsubstantiated. An Unsubstantiated finding means that 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. An exit interview was conducted where reports (LIC 9099 & LIC9099-C) were discussed, and a copy was provided to Administrator Woofter at the conclusion of the visit. The facility’s policy regarding falls indicated the staff should not have attempted to move the resident, but instead either summoned emergency medical services (i.e., call 911), or contact the physician for further instructions. The facility staff who assisted R1 after the unwitnessed fall helped R1 off the floor and escorted R1 back to bedroom, which was not in accordance with the facility’s policy for falls. Facility staff stated during investigation that R1 denied having pain when asked. However, records review indicated that R1’s primary diagnosis was Dementia (loss of cognitive functioning thinking, remembering, and reasoning to such an extent that it interferes with a person's daily life and activities). It is not known if R1 was able to have understood or have been able to verbalize the presence and location of pain. Facility staff also reported that R1 “looked confused” following the incident. On 8/14/2022, at approximately 7:00–7:30 am, R1 was observed with skin tears, blood on pajamas near elbows, signs of pain and unable to sit up. On the same day around 11:30 am, R1 was admitted to the local hospital. According to medical records, R1 had had a lumbar compression fracture, a mildly displaced left femoral intertrochanteric fracture, and skin tears on both elbows. Medical records also indicate the cause of the injuries was an accidental fall. Additional records review found that the facility’s admission agreement indicated, “This is a non-medical care facility that does not and cannot provide medical, intermediate or skilled nursing care.” In addition, “the following basic services will be provided “Monitoring and appropriate reporting of resident needs and condition to family and physician.” It is unknown what additional change of condition occurred with R1 during the time of the fall until medical care was sought. R1 passed away on 8/16/2022. R1’s Certificate of Death indicated the immediate cause of death was cardiopulmonary arrest (also known as cardiac arrest when the heart stops pumping blood and breathing stops) and Alzheimer’s disease (a brain disorder that slowly destroys memory and thinking skills, and eventually, the ability to carry out the simplest tasks) as the underlying cause. Also, other significant conditions contributing to death were left hip fracture, and L-1 (lumbar, part of the spine, and first bone of the five lower back bones) compression fracture. Based on the investigation, the allegation that facility staff did not seek medical attention in a timely manner for resident is Substantiated. A substantiated finding means that the allegation is valid because the preponderance of evidence standard has been met. Regarding the allegation, neglect/lack of care and supervision resulting in resident sustaining multiple injuries, investigation reveals that on 8/13/2022, facility staff left R1 unattended sitting at the dining table for an unknown period of time. R1 had an unwitnessed fall. Staff returned to the dining room on or around 4:30 pm and found R1 on the tile floor near a door. Staff assessed R1 and transported R1 back to R1 bedroom and put R1 in bed. Emergency services were not contacted for R1 on day of fall. After the fall, R1 did not receive medical care and services until 8/14/2022. In addition, neither R1’s responsible party nor physician were immediately notified by the facility after the unwitnessed fall. Interview and records reveal that R1 had a previous fall in October 2020 and per facility staff, R1’s ability to walk and function with minimal assistance had declined. Facility record review reveals, R1 had primary diagnosis of dementia. In addition, per Physician’s Report, dated 6/03/2021, R1 assessment included but was not limited to indication that R1 was unable to ambulate without assistance, experienced dizziness, was confused/disoriented at times with sundowning behavior (a state of confusion that occurs in the late afternoon and lasts into the night causing various behaviors, such as confusion, anxiety, aggression or ignoring directions, and can lead to pacing or wandering) due to dementia, and required assistance with medication management and daily self-care, including feeding self. R1 also had a visual impairment, glaucoma, (an eye condition that can cause vision loss) of the left eye. During investigation, a facility caregiver stated that R1 “required a walker but refused or forgot to use it.” Two caregivers also stated that R1 required assistance to the dining area by physically holding R1 hand/arm and walking near or next to R1 because R1 was weak and at risk of falling. In addition, R1 was at risk of choking, yet R1 was left unattended in dining room with food in front of R1. In addition, facility admission agreement for R1 indicates that basic services such as “Assistance with activities of daily living: care and supervision which includes assistance with medication, dressing, toileting, bathing, grooming, mobility, telephoning, and correspondence; central storing and distribution of medication will be provided." Based on the investigation, the allegation of neglect/lack of care and supervision resulting in resident sustaining multiple injuries (fractures) is Substantiated. A substantiated finding means that the allegation is valid because the preponderance of evidence standard has been met. In addition, this violation posed an immediate Health and Safety risk to resident(s) in care. An Immediate Civil Penalty of $500 is being assessed. The Administrator was also informed that an enhanced civil penalty may be assessed based on Health and Safety Code § 1569.49 Regarding the allegation, Neglect/lack of care and supervision resulting in resident sustaining skin tears, investigation reveals on 8/13/2022, R1 was observed with skin tears, blood on pajamas near elbows, signs of pain and unable to sit up. On the same day around 11:30 am, R1 was admitted to the local hospital. According to medical records, R1 had had a lumbar compression fracture, a mildly displaced left femoral intertrochanteric fracture, and skin tears on both elbows. Medical records also indicate the cause of the injuries was an accidental fall. R1 fell while in care and sustained skin tears on the elbows. Staff denied seeing the skin tears the night before when they conducted a body check after the fall. Staff did not call 911, family, or a supervisor to report the fall. Based on the investigation, the allegation of neglect/lack of care and supervision resulting in resident sustaining skin tears is Substantiated. A substantiated finding means that the allegation is valid because the preponderance of evidence standard has been met. Regarding the allegation, facility staff did not inform authorized representative of resident's injuries, the investigation reveals that on 8/13/2022, R1 had an unwitnessed fall. Staff found R1 on the tile floor of the dining room. Staff assessed R1 and transported R1 back to R1's bedroom and put R1 in bed. At the time of the fall (incident), it was found that R1 had been left unattended. Emergency services were not contacted for R1 on the day of the fall. Neither R1’s responsible party nor physician were immediately notified by the facility after the unwitnessed fall. In addition, facility staff revealed that night shift was not informed that R1 had an unwitnessed fall during the day. On 8/14/2022, R1 was observed with skin tears, blood on pajamas near elbows, signs of pain and unable to sit up. On the same day around 11:30 am, R1 was admitted to the local hospital. According to medical records, R1 had had a lumbar compression fracture, a mildly displaced left femoral intertrochanteric fracture, and skin tears on both elbows. Review of facility's admissions agreement reveals basic services includes, "monitoring and appropriate reporting of resident needs and conditions to family and physician." On 8/15/2022, staff received disciplinary counseling for not reporting R1’s fall to family, appropriate supervisor, and not following facility’s fall policy to call 911 emergency services. An incident report dated 8/15/2022 shows R1 had an unwitnessed fall in the dining room but did not include signs of pain or injuries. Based on this investigation, the allegation of facility staff did not inform authorized representative of resident's injuries is Substantiated. A substantiated finding means that the allegation is valid because the preponderance of evidence standard has been met. An exit interview was conducted where reports (LIC9099-A, LIC9099-C, LIC9099-D, LIC421M) where discussed and provided with appeal rights to Administrator Woofter at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jun 24, 2025 · control 56-AS-20220909164619

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jun 26, 2025

Additional Personal Rights of Residents in Privately Operated Facilities(a)In addition to the rights listed in Section 87468.1... residents...shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs...delivered by staff that are sufficient in numbers, qualifications, and competency...This requirement is not met as evidenced by: R1 sustained an unwitnessed fall around 4:30pm on 8/13/22. It was not until around 11:30 am on 8/14/22, when R1 received medical care to meet R1 injuries (needs). Licensee did not ensure that R1 received care and supervision to meet R1 needs. On 8/13/2022, R1 was left unattended by staff in the dining room, for an unknown period of time. R1 sustained multiple fractures and skin tears. Medical records indicate the cause of the injuries was a fall. This posed an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 24, 2025

Plan of correction: The Licensee/Administrator has a agreed to conduct inservice training on regulation cited an provided documentation of training to the Licensing Agency by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Jun 26, 2025

Observation of the Resident . The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional...functioning... appropriate assistance is provided when such observation reveals unmet needs. When changes such as...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 requirement is not met as evidenced by: Staff observed R1 with skin tears, unable to sit up without pain and did not notify R1 physician regarding changes in the R1's condition. This posed an immediate health, safety, and personal risk to residents in care.the state’s words, verbatim · CDSS document, Jun 24, 2025

Plan of correction: The Licensee/Administrator has a agreed to conduct inservice training on regulation cited an provided documentation of training to the Licensing Agency by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(f) · Plan of correction due date: Jun 26, 2025

Admission Agreements(f)The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement is not met as evidenced by: Staff received disciplinary action for not appropriately/immediately reporting falls and injuries (condition) to R1's authorized party and physician. Admissions agreement reveals basic services includes, "monitoring and appropriate reporting of resident needs and conditions to family and physician". This posed a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 24, 2025

Plan of correction: The Licensee/Administrator has agreed to provide inservice training on regulation cited and submit documentation of training to the licensing agency by POC due date.

Allegation investigated: Residents are not assisted with their toileting needs

Licensing Program Analysts (LPA) Becky Mann and Antoinette Davis conducted an unannounced visit to the facility to initiate a complaint investigation. LPA Mann and Davis met with Linda Woofter, Administrator and explained the purpose of today's visit. The investigation consisted of LPAs observations, pertinent document reviews, and interviews with staff and residents. The allegation that residents are not assisted with their toileting needs. Based on LPAs observations, Resident #1 (R1) was found in their room while laying on their bed, was found soaked in adult pull-ups. The right side of R1 pants were soaked in urine. LPAs could smell the urine in the room while interviewing R1. Based on LPAs observations, the above allegation is Substantiated. A determination that the complaint is substantiated means that the allegation is/are valid because the preponderance of the evidence standard has been met. An exit interview was conducted where this report was discussed and provided to Linda Woofter, Administrator and appeal rights. Substantiated The allegation that kitchen staff do not practice personal hygiene. Five (5) staff interviewed stated that kitchen staff does practice personal hygiene. Six (6) residents interviewed stated that kitchen staff does practice personal hygiene. Based on LPAs observations, kitchen staff does follow proper hygiene and safety guidelines while handling food. The allegation that residents are not assisted with showers appropriately. Three (3) staff interviewed stated that residents are assisted with showers appropriately. Three (3) residents interviewed stated that they are assisted with showers appropriately. LPAs observed a monthly shower log that staff use to maintain shower frequency. Based on LPAs observations, interviews and record reviews, the shower log is accurate and properly maintained. Based on evidence obtained during this investigation, the allegations above are Unsubstantiated; meaning that 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. An exit interview was conducted where this report was discussed and a copy of this report was provided to Linda Woofter, Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 8, 2025 · control 18-AS-20210802150441

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87625(b)(3) · Plan of correction due date: May 15, 2025

87625 Managed Incontinence (b) In addition to Section 87611, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidenced by: Based on LPAs observations staff did not change resident's pull ups in a timely manner. LPAs observed resident soaked in adult pull up which poses a health and safety risk to residents in carethe state’s words, verbatim · CDSS document, May 8, 2025

Plan of correction: Administrator told staff to change resident adult pull ups while LPAs was at the facility. LPAs recommended facility maintain a incontinence log for residents and email log to LPA by Plan of Correction (POC) due date

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Sarina Ramirez, Eldin Serrano, and Edith Conchas made an unannounced visit to the facility to conduct a required annual inspection. LPAs met with Administrator Linda Woofter, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (61), a current census of (51). LPAs conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility does not have a swimming pool or similar bodies of water. The facility has sufficient lighting and is maintained at a comfortable temperature. The facility has sufficient indoor and outdoor space for resident activities. The facility is equipped with operating smoke detectors/carbon monoxide alarms, working laundry equipment, and telephone service. Resident’s showers, toilets, and hand washing areas were operating properly. The hot water temperature in two (2) resident bathrooms measured between 138.5 and 145.2 degrees F, deficiency will be issued. Five (5) resident’s bedrooms had beds, bed linen, chairs, dresser, storage space and sufficient lighting. The facility has sufficient linens, towels, and personal hygiene items for residents. The facility has posted in a common area, facility license, personal rights, facility sketch, emergency disaster plan and telephone numbers, CCLD complaint poster, and Ombudsman poster. Food Service: Facility kitchen and dining area are maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care. Sharps and chemicals were kept locked and inaccessible to residents in care. Continuation on LIC – 809C: Care & Supervision: Facility has 24-hour/7days a week care staff. Facility staff have current CPR/first aid training. Medical Related Services: Resident’s medications are labeled and centrally stored in a locked cabinet. Record Review: Five (5) Staff files reviewed were observed to be complete. Eight (8) Resident files reviewed were observed to be complete, however R1 and R2 had missing TB results; Technical Violation addressed. Facilities last disaster drill was conducted on 4/10/25. Based on observations and record review technical violation discussed, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, a copy of the report with LIC 902, LIC 9099D, and appeal right were provided to Administrator Linda Woofter.the state’s words, verbatim · CDSS document, May 7, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff are locking residents inside of the facility.

Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to initiate and deliver the complaint investigation for the allegations above. LPA Allen met with Linda Woofter administrator who was informed of the purpose of the visit and allegation. The investigation consisted of interviews with staff members, residents, record review and observations. LPA Allen conducted interviews with staff members who all stated residents are allowed to come in/out of the facility as they please but are required to sign out if they leave the premises for safety reasons. Staff members have stated residents have never been denied exiting the facility. Interviews with residents have stated they have always been required to sign out of the facility prior to leaving for safety reasons and have never been held against their will. During the visit LPA observed residents leaving in/out of the facility after signing out. LPA also observed signed addendums during the visit that state the facility has a secured environment for memory care residents at the facility. Unsubstantiated Based on the evidence gathered during the investigation, the above allegation is found to be Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted where this report was discussed and provided to Linda Woofter- Administrator at the conclusion of the visit with appeal rights.the state’s words, verbatim · CDSS document, Dec 9, 2024 · control 56-AS-20241204085340

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Administrator Linda Woofter and was granted entry to the facility.The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (61) current census (51). LPA was accompanied by Facility Administrator, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident’s bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside Med-room office inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed three (6) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed four (4) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator Linda Woofter.the state’s words, verbatim · CDSS document, May 11, 2024