Ca Caring Hands

Allegation investigated: Resident sustained multiple injuries due to staff abuse or neglect.

On 02/16/2026, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with care staff Arianne Dagohoy and explained the purpose of the visit. The purpose of this visit is to deliver complaint finding for the above allegation. Per care staff Dagohoy, Administrator Michael Jankowski is out of the state on vacation on 02/07/2026 and will return at the end of the month. The facility census was five (5) residents with two (2) staff present. It was alleged that the resident sustained multiple injuries as a result of staff abuse or neglect. During the course of this investigation, it was learned that Resident 1 (R1) had been placed on hospice and was diagnosed with an underlying health condition that causes involuntary, spasm-like movements. These movements frequently caused R1 to thrash, resulting in self-inflicted injuries to their arms, legs, and head, including impacts against the bed, wheelchair, or other surfaces such as a sofa. CONTINUED LIC 9099-C Unfounded The facility had received physician orders to use a blanket restraint system while R1 was in bed to prevent them from accidentally falling or flinging themselves off the bed. All staff members interviewed denied ever hitting R1 or any other resident, stating that observed injuries were consistent with R1’s medical condition. In an interview with three out of three residents who all stated they do feel safe living in the home and have no concerns about the allegations. Moreover, hospital staff found no concerns about abuse and documented that R1’s injuries were consistent with their underlying condition. Based on records review, the allegation was unable to corroborate the allegation. This agency has investigated the complaint alleging It was alleged that the resident sustained multiple injuries as a result of staff abuse or neglect. The department have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Feb 17, 2026 · control 27-AS-20250825160003

Allegation investigated: Staff are inappropriately restraining resident in care. Staff are chemically restraining resident in care. Staff are not meeting resident's toileting needs while in care. Staff are not preventing resident's bed from being infested by bugs. Staff are not properly addressing resident's wounds.

THIS IS AN AMENDED VERSION OF THE ORIGINAL REPORT TO REMOVE ALLEGATION #3. On 02/12/2026, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with care staff Arianne Dagohoy and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the above allegations. Per care staff Dagohoy, Administrator Michael Jankowski is out of the state on vacation on 02/07/2026 and will return at the end of the month. The facility census was five (5) residents with two (2) staff present. It was alleged that facility staff were inappropriately restraining residents in care. This investigation consisted of interviews with staff, residents, the residents’ responsible parties, an outside agency and review of records. LPA Lee interviewed three out of three residents, all of whom stated they had no concerns that facility staff are restraining residents and reported that they feel safe living in the facility. CONTINUED LIC 9099-C Unsubstantiated THIS IS AN AMENDED VERSION OF THE ORIGINAL REPORT TO REMOVE ALLEGATION #3. LPA Lee also interviewed three facility staff, all of whom denied the allegation and stated that Resident 1 (R1) had a physician’s order authorizing the use of a blanket and a wheelchair safety belt for R1’s safety. An interview with an outside agency indicated that they had not observed any residents being restrained. Additionally, an interview with R1’s responsible party revealed no concerns regarding the allegations, abuse, or neglect by facility staff. A review of records showed that R1 was placed on hospice care and that a physician’s order was in place authorizing the use of a floating blanket system for bed safety and a wheelchair safety belt to provide protective postural support. Based on the interviews conducted and the records reviewed during the investigation, LPA Lee was unable to corroborate the allegation. It was alleged that staff were chemically restraining residents in care. This investigation consisted of interviews with staff, residents, and an outside agency, as well as a review of records. LPA Lee interviewed three of three residents, all of whom stated they had no concerns regarding their medications and reported that medications are administered by facility staff. LPA Lee also interviewed three facility staff members, all of whom denied the allegation and stated that medications are administered in accordance with physicians’ orders and that no residents are chemically restrained. An interview with an outside agency indicated no concerns regarding residents’ medications. A review of medications was conducted for five out of five residents by examining the medications stored in each resident’s medication box. The review indicated that all medications present were prescribed by a physician. During records review, it was learned that the facility was not consistently or accurately documenting medication administration on residents’ Medication Administration Records (MARs). Additionally, the facility was not properly maintaining centrally stored medication destruction records; however, no evidence was identified to indicate that medications were administered for the purpose of chemical restraint. It was also learned that Resident 1 (R1)’s medications were removed from the facility by hospice following R1’s death and were therefore unavailable for review. Based on R1’s MAR records it indicated that R1 was receiving R1 medication as it was initialed given for the month of June 2025 to November 2025. Based on the interviews conducted and a review of available records, there was insufficient evidence to support the allegation that staff are chemically restraining residents in care. CONTINUED LIC 9099-C THIS IS AN AMENDED VERSION OF THE ORIGINAL REPORT TO REMOVE ALLEGATION #3. It was alleged that staff were not meeting residents’ toileting needs while in care. This investigation included interviews with staff, residents, and an outside agency, as well as direct observations. LPA Lee interviewed all three residents, each of whom reported no concerns regarding their incontinence care and confirmed that staff assist them as needed. Interviews with three facility staff members denied not assisting residents with toileting needs. An outside agency also reported no concerns and stated that they had not observed any incontinence odors at the facility. During a facility visit on January 30, 2026, LPA Lee did not detect any incontinence odors and observed a staff member assisting Resident 2 (R2) with incontinence care. Additionally, a whiteboard located at the entry wall was observed displaying residents’ names, responsible party contact information, doctor’s appointments, and the date of each resident’s last bowel movement. Based on the interviews and observations conducted during this investigation, LPA Lee was unable to corroborate the allegation. It was alleged that staff were not preventing residents’ beds from being infested by bedbugs. This investigation included interviews with staff, residents, and an outside agency, as well as observations and records review. LPA Lee interviewed three facility staff, all of whom reported that they had not observed bedbugs on residents’ beds and confirmed that the facility uses pest control services. Interviews with all three residents also indicated that they had not seen bedbugs on their beds and had no concerns regarding the allegation. Additionally, an outside agency reported no observations of bedbugs in residents’ rooms or on their beds. During a facility visit on January 30, 2026, LPA Lee toured the facility with care staff Dagohoy and inspected six resident bedrooms, including beds, sheets, and mattresses. No pests were observed. CONTINUED LIC 9099-C Records review confirmed that the facility does have pest control services. Based on the interviews, observations, and records review, LPA Lee was unable to corroborate the allegation. It was alleged that staff were not properly addressing a resident’s wounds. During this investigation, it was determined that Resident 1 (R1) had been placed on hospice and was diagnosed with a underlying health condition that causes involuntary, spasm-like movements. These movements often resulted in R1 thrashing, which caused self-inflicted injuries to the arms, legs, and head, including impacts against the bed, wheelchair, or other surfaces such as a sofa. All staff interviewed denied not addressing R1’s wounds, stating that the wounds were being regularly cleaned and dressed by the hospice nurse and that these interventions were documented in R1’s hospice notes. Records review confirmed that R1’s wounds were being addressed by the hospice nurse and that all care was documented in R1’s file. Additionally, hospital staff reported no concerns of abuse and documented that R1’s injuries were consistent with their underlying medical condition. Based on the review records, the allegation could not be corroborated. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are 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(s)occurred.the state’s words, verbatim · CDSS document, Feb 12, 2026 · control 27-AS-20250825160003

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Pang Lee arrived unannounced at the facility on 02/12/2026 to conduct a case management visit. LPA Lee met with care staff, Arianne Dagohoy, and explained the purpose of the visit. Care staff Dagohoy reported that Administrator Michael Jankowski has been out of state on vacation since 02/07/2026 and is expected to return at the end of the month. The purpose of the visit was to follow up on deficiencies identified during complaint investigation control number 27-AS-20250825160003. On 01/30/2026, a medication review was conducted for five (5) residents by examining the medications stored in each resident’s medication box. The review confirmed that all medications present were prescribed by a physician. However, upon review of facility records, it was observed that the facility was not consistently or accurately documenting medication administration on the residents’ Medication Administration Records (MARs), specifically by not initialing when medications were administered. In addition, the facility was not properly maintaining Centrally Stored Medication Destruction Records (CSMDR). For all five residents, the CSMDRs were missing the start dates for multiple medications, indicating that the dates the medications were first administered upon delivery to the facility were not documented. During the visit, residents’ bedrooms were inspected. LPA Lee observed a video camera in Bedroom #3 for Resident 1 (R1) and in Bedroom #5 for Resident 2 (R2). Two small video monitoring screens were also observed in the entry/receiving area. CONTINUED LIC 809-C Based on interviews with care staff Dagohoy and Administrator Michael, the cameras were installed for resident safety due to fall risks. It was further learned that the facility did not request an exception from the department for the use of the cameras. Record review indicated that the facility has a signed Exception and Authorization form for R2 that was signed by R2's responsible party, while the form for R1 is pending. The following deficiencies were observed and cited pursuant to the California Code of Regulations, Title 22, and the California Health and Safety Code. The deficiencies are documented on the LIC 809-D page. An exit interview was conducted, and copies of the LIC 809 report, LIC 809-D page, and appeal rights were provided to the facility.the state’s words, verbatim · CDSS document, Feb 12, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(6) · Plan of correction due date: Mar 6, 2026

87465(a)(6) Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. ... (6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Based on observation, interview, and record review, the licensee did not ensure to maintain residents’ medication records which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: Facility staff agree to conduct incidental and medical in-service training for all Medication Technicians by POC date 03/06/2026. Facility staff agree to email LPA Lee in-service training documents and staff sign in sheet for the training along with a statement of acknowledgment of reading and understanding the regulation cited.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Mar 6, 2026

87468.2 (a)(1) 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: (1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement is not met as evidenced by: Based on observation and interview, residents were not permitted a reasonable level of privacy in their private bedrooms since there was a camera in the resident’s room without an exception from the department, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: Licensee agrees to provide a written acknowledgement that cameras or other audiovisual recording devices are not to be utilized in any resident rooms prior to approval from the department. POC due date by 03/06/2026 at the end of day 5:00 PM.

Type of visit: Required - 1 Year

On 08/06/25, an unannounced annual inspection was made to this facility by Licensing Program Analyst (LPA) Sommer Hayes. The LPA identified themselves and the purpose of the visit and asked to speak to the Designated Facility Administrator (DFA). LPA was met by a caregiver. The Administrator, Michael Jankowski and Designated Facility Administrator (DFA) Mary Rose Jankowski arrived shortly after, and a brief interview followed. LPA was allowed entry into the facility that is licensed to serve a total capacity of 6 residents. The current census is 5. This facility is licensed for 6 non-ambulatory residents and a hospice waiver granted for 6. A fire drill was held on 03/15/25 for 10.5 minutes. The drill included 2 staff and 4 residents. LPA observed there was no time noted on the log for fire drills. LPA toured the facility with the Administrator, Michael Jankowski and DFA with Mary “Rose” Jankowski. The kitchen was accessible to residents and clean and sanitary. The LPA observed 7 days of non-perishable food supplies and observed 2 days of perishable food supplies. LPA Hayes also observed a delivery of food during this visit. There were enough clean plates, cups and bowls and cutlery to meet capacity. The garage was not accessible to residents. LPA observed the storage of incontinence supplies, washer and dryer and a small storage with a door. Inside LPA observed more incontinence supplies. The facility living room was clean and free of obstruction. The room temperature reading was 73 degrees Fahrenheit which fell within the Title 22 regulations of 68-85 degrees Fahrenheit. The seating is efficient for the number of residents in this facility. Continued on 809-C There was a fire extinguisher (last serviced 01/2025 by River City Fire), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and making medication inaccessible to residents. The Medication Administration Record (MAR) was reviewed. LPA reviewed 5 resident records and 2 staff records. LPA observed the residents’ bedrooms. Bedrooms were clean and furnished with beds, bed sheets, bed comforters, lighting, a chest of drawers. LPA observed the backyard of the facility. There was a shaded area with seating for residents to enjoy. Fencing was in good repair. There were no bodies of water. Per California Code of Regulations, Title 22, 0 deficiencies were observed during today’s visit. Exit interview was conducted. A copy of this report was provided to the Administrator, Michael Jankowski and Mary “Rose” Jankowski.the state’s words, verbatim · CDSS document, Aug 6, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 7/24/24 at 8:30am. Administrator certificate expires 8/11/25. LPA met with Michael Jankowski, Administrator and stated the purpose of todays visit. The facility is licensed for a capacity of 6 non- ambulatory of which 6 may receive hospice care services. There is 1 resident receiving hospice care services at this time. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. The temperature inside the facility was observed to be at 69*F which is within the required range of 68-85*F. The hot water temperature was measured at 109.4*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and antiseptic solution. LPA observed 4 residents and 2 staff files during this visit. LPA observed 2-day perishables and 7-day non-perishables. Upon a file review the following items were discussed to be submitted with any changes annually: Licensing fees-Current Criminal Record Clearances LIS536-Current Administrative Organization LIC309-Current Designation of Administrative Responsibility LIC308-Submit Personnel Report LIC500-Submit Affidavit Regarding Client/Resident Cash Resources LIC400-NA Surety Bond LIC402-NA Facility Floor Plan/Plot Plan LIC999-Current Fire Clearance (consistent with terms and limitations of license)-NA Qualifications of Administrator/Facility Manager-Submit Articles of Incorporation/Organization, Constitution and bylaws-NA Partnership Agreement-NA Control of Property-Submit Emergency Disaster Plan LIC610-Submit Plan of Operation (Restricted Health Care Plan)-NA Admission Policies and Procedures-NA Health Screening Report-Facility Personnel LIC503-NA Bacteriological Analysis of Private Water Supply-NA In-service Training Program-NA Medication Procedures-NA Transportation Procedures-NA Job Description/Personnel Policies-NA Exemptions/Waivers and Exceptions-Current First aid/CPR certificates-Current Liability Insurance-(if applicable)Submit Infection Control Plan-Current Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. Exit interview held. A copy of todays’ report provided.the state’s words, verbatim · CDSS document, Jul 24, 2024

Allegation investigated: Facility did not provide resident records upon request

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct an investigation of the above mentioned allegation on 6/14/24 at 12:15pm. LPA met with Caregiver Arinanne Dagohoy who contacted the Administrator regarding the purpose of the visit. LPA interviewed Administrator #1 (Adm 1) and (Adm 2) and Staff 1 (S1) during this visit. The investigation revealed that a copy of the residents file was not provided to the attorney of resident #1 (R1). Based on confirmation through interviews, the preponderance of evidence standard has been met, therefore the above allegation(s) are found to be SUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Div.6, Ch. 8, deficiencies are being cited on the attached 9099D during this visit. If any deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Administrator was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, and a copy of this report was provided. Substantiatedthe state’s words, verbatim · CDSS document, Jun 14, 2024 · control 27-AS-20240613165603

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(2) · Plan of correction due date: Jun 15, 2024

Additional Personal Rights of Residents in Privately Operated Facilities 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: To have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement is not met as evidenced by: Based on interviews confirming Administrator did not provide a copy of R1's file upon request by R1's attorney. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 14, 2024

Plan of correction: Licensee/Administrator shall submit a complete copy of the residents file to the attorney by POC due date. Confirmation of completion shall be faxed to the office.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on a subsequent visit on 6/14/24 at 12:15pm. LPA was met by Michael Jankowski, Administrator and stated the purpose of the visit. LPA observed a electrical outlet with a missing cover. Michael Jankowski took a photo and indicated it will be replaced today. Based on the confirmation and observation of both the Administrator and LPA the preponderance of evidence standard has been met. Per California Code of Regulations (CCRs) - Title 22, Div.6, Ch. 8, deficiencies are being cited on the attached 809D during this visit. If any deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Administrator was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 14, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Jun 15, 2024

Maintenance and Operation The facility shall be ...safe...and in good repair at all times...for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation of Administrator and LPA confirming the cover was missing. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 14, 2024

Plan of correction: Licensee/Administrator shall ensure the cover of the electrical wall outlet is replaced. Confirmation of completion shall be faxed to the office by POC due date.

Allegation investigated: Facility staff left resident laying in soiled bedding. Facility staff did not meet resident's hygiene needs. Facility staff did not rotate a resident with pressure injuries. Facility staff did not follow resident's hospice care plans.

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conclude a complaint investigation on 12/28/23 at 9am. LPA met with Administrator Shahbaz Khan and stated the purpose of the visit. On 12/1/23, LPA obtained copies of resident #1 (R1) complete file which included hospice records and interviewed staff #1 (S1-S2), Applied Palliative and Hospice Services Inc, representative, complainant and responsible party. LPA reviewed the documents obtained and conducted additional interviews today of staff # 3 and Administrator. LPA obtained copies of the visitation log for November 2023. The investigation revealed that R1 was receiving hospice care services during the time of residing in the facility. A review of the Applied Palliative and Hospice Services, Inc. Care Notes dates from 1/30/23 to 11/29/23 revealed that R1 was receiving wound care from the Hospice Agency beginning 4/26/23. Based on interviews R1 had skin tears, and rashes upon admission that cleared. This was from having fragile skin integrity due to progressive Parkinsons and Vascular Disease diagnosis. See 9099C for Continuation... Unfounded 9099 Continued... All interviews of staff, administrator, Hospice representative concur that R1 was not left laying in soiled bedding. All concur that R1s hygiene was properly taken care of throughout every day. All concur that the hospice care plan was being followed which entailed rotating and turning resident. LPA observed through a review of the hospice documentation that the hospice agency met with R1s family on several occasions regarding issues and concerns explaining the progression of R1s diagnosis and care needs. During interviews licensed medical professionals did not confirm the facility staff were at fault. Based on the review of documentation and interviews the preponderance of evidence has not been met. The allegation is deemed UNFOUNDED. "The allegation is UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. This Department has therefore dismissed the complaint." Per California Code of Regulations, no deficiencies were observed or cited. Exit interview held, and a copy provided.the state’s words, verbatim · CDSS document, Dec 28, 2023 · control 27-AS-20231130162018

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to obtain additional information regarding the care and supervision of residents. LPA met with Shahbaz Khan and stated the purpose of the visit. LPA observed three resident files (R1-R3). LPA interviewed Applied Hospice staff during this visit. Administrator Shahbaz Khan contacted the Fire Dept to schedule a pre-inspection to ensure and determine which rooms are allowed to maintain bedridden residents as the facility is approved for 6 hospice residents. LPA reviewed the meaning of exception, waiver, bedridden, total care, records, non-ambulatory, and the use of Technical Support Program (TSP). Of the 3 files reviewed, LPA observed R1 is not using a catheter, R2 is utilizing hospice services and periodically using a condom catheter which Home Health is maintaining through visits 5x week along with using incontinence supplies. R3 is using a purewick catheter but is able to maintain the self-care with assistance. R4 who needed catheter care was relocated by the POA as there was no exception in place. LPA inquired about the exception requests that was submitted to the Department. LPA deemed the exceptions are not needed at this time. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview held, copy of report giventhe state’s words, verbatim · CDSS document, Oct 20, 2023

Type of visit: Case Management - Annual Continuation

On 10/3/23 at approximately 2:40pm Licensing Program Analyst (LPA) Jennifer Fain arrived at this facility unannounced to continue an annual inspection visit. LPA met with Homaira Momen and explained the purpose of the visit. During this inspection 4 of 6 resident files and 6 of 6 staffing files were reviewed for regulatory compliance. Staff files contained required contents including staff training requirements. 1 of 6 Staff files was missing a signed Criminal Record Statement. All staff noted on LIC 500 contained criminal background clearances. Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. LPA observed the 602 for Resident 2 (R2) stated bedridden status. The facility Plan of Operations does not address bedridden care. LPA observed the facility is licensed for 6 non-ambulatory with 6 hospice waivers, but does not have bedridden status. Technical Assistance (TA) was provided regarding fire clearance and waivers. LPA observed R2 at the dinner table. Licensee will confirm bedridden status and apply for clearance and waivers as needed. LPA observed the 602 for Resident 5 (R5) states R5 has dementia and is “at risk if allowed direct access to personal grooming and hygiene products.” LPA observed hygiene products in R5’s room and shared bathroom. TA was provided and products were removed. LPA observed cameras in 2 of 6 resident rooms and two in the common areas of the residence. The cameras in the resident rooms were removed immediately. LPA provided (TA) regarding cameras in residence. Cameras must be addressed in the Plan of Op and admissions agreement. Licensee states Plan of Op will be updated and an addendum to the Admissions agreement will be signed by each resident or responsible party. Water temperature in common bathroom reads 117.7*F which is within the regulated temperature range of 105*F to 120*. Temperature on the heating and air unit read 69*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were tested and in working order. The fire extinguisher was found to be in compliance. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. The first aid kit was observed to have adequate supplies and was accessible to staff. Facility does not contain any bodies of water. Facility’s liability insurance is current and up to date per regulatory requirements. LPA observed personal rights, resident council and complaint information posted. Facility has appropriate internet access available for resident use. Licensee was offered and accepted participation in the TSP Program. The facility is not in compliance with the California Code of Regulations, and the deficiencies can be found on the LIC 809-D page. An exit interview was conducted with Homaira Momenand and a copy of the LIC 809 reports, LIC 809-D pages, and Appeals rights were provided.the state’s words, verbatim · CDSS document, Oct 3, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2 · Plan of correction due date: Oct 3, 2023

(a)… residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations... This requirement is not met as evidenced by: Based on observation and interview the licensee did not provide privacy to 2 of 6 residents due to cameras in their private rooms, which poses a potential Health, Safety and/or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 3, 2023

Plan of correction: The cameras were removed from the residents’ rooms. No further correction is required.