Camelot Care Bucks Harbor

Type of visit: Required - 1 Year

On 11/20/2025 at 12:30 PM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived at the facility to conduct an unannounced annual inspection. LPA Hughes met with caregiver Allan Arandela and explained the purpose of the visit. Staff called the facility designated administrator to inform that CCLD was present in the facility. The current census is 4 with 2 facility staff. This facility is a single story building licensed to serve (6) non-ambulatory residents. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility to be free of odor, clean and in good repair. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 112.4 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mats were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the kitchen area and was last serviced on 06/20/2025. LPA observed the facility has a public telephone in the common area and the facility has the required posters posted. Facility thermostat was observed at 73 degrees Fahrenheit. LPA observed toxins located in the kitchen cabinet kept locked and inaccessible to residents. LPA observed sharp knives kept locked in the kitchen and inaccessible to residents. LPA checked medication storage and found medication to be locked away and inaccessible to residents. Continuation 809-C LPA reviewed 2 out of 4 residents medications and the medication administration record (MAR) was complete. The first aid kit was checked and contained the required components. LPA requested resident and staff files for review. LPA reviewed 4 out of 4 resident files and they were complete. LPA reviewed 3 staff files, and it was complete. LPA reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared. The following documents will be email to LPA by 11/21/2025: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (3) LIC 610 Current Emergency Disaster Plan (4) Proof of Current Liability Insurance (5) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulations, and a copy of these LIC 809 reports were provided to the facility.the state’s words, verbatim · CDSS document, Nov 20, 2025

Allegation investigated: The facility does not have enough staff to meet resident needs. Facility does not have appropriate staff available to assist in an emergency Housekeeping is not completed on a regular basis. Staff do not follow infection control.

On 02/04/25 at 8:36 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with direct care staff Janelyn Aragon and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 6. A brief interview with conducted with administrator Araceli Cantiller. It was alleged that the facility does not having enough staff to meet residents’ needs and that the facility does not have appropriate staff to assist residents in an emergency. The investigation involved reviewing records, interviewing staff, residents, and 2 regular visitors, as well as observations. According to the facility’s LIC 500 Personnel Records, from Monday to Thursday, there are three staff members on-site from 7:00 AM to 12:00 PM, and two staff members from 12:00 PM to 7:00 AM. On Fridays through Sundays, there are two staff members from 7:00 AM to 7:00 PM. The facility’s LIC 610D Emergency Disaster Plan outlines protocols for emergencies. Continued LIC 9099-C Unsubstantiated LPA Lee interviewed 4 out of 5 residents who expressed no concerns about regarding staffing and during emergencies. Additionally, all three facility staff members denied the allegation, affirming that they assist residents with activities of daily living (ADLs) and any other needs, and they believe the staffing level is sufficient for emergencies. Furthermore, 3 regular visitors to the facility reported no concerns about staffing and confirmed seeing three staff members on-site. On 01/15/25, LPA Lee observed three staff members from 8:30 AM to 12:00 PM and two staff members from 12:00 PM to 3:55 PM. Based on interviews and statements gathered throughout the investigation, LPA Lee was unable to corroborate the allegations. It was alleged that the facility housekeeping is not completed on a regular basis. The investigation involved reviewing records, interviewing staff, residents, and three regular visitors, as well as observations. Facility record showed that the facility has a cleaning schedule in place. In interviews with residents, 4 out of 5 residents stated they had no concerns about housekeeping and that their rooms are cleaned by the care staff. Additionally, 3 regular visitors reported that the facility appeared clean and expressed no concerns. On 01/15/25, LPA Lee toured the facility, inspecting residents' bedrooms, bathrooms, and all areas used by residents. All areas were observed to be clean, sanitary, and comfortable. The facility appeared well maintained, with no concerns noted during the visit and today’s visit. Based on the interviews and observations made during the investigation, LPA Lee was unable to corroborate the allegations. It was alleged that the facility is not following infection control. The investigation included a review of records, interviews with staff, residents, and three regular visitors, as well as observations. Facility records showed that the facility has infection control measures in place. In interviews with residents, 4 out of 5 resident stated that care staff wear gloves when assisting them with care and expressed no concerns, denying the allegations. 3 facility staff members were initially unable to explain the term "hygiene" until LPA Lee provided examples. Once clarified, staff confirmed that they wash their hands before and after assisting with incontinence care and wear gloves during this process. It was unclear if a language barrier contributed to the confusion. 2 regular visitors reported no concerns regarding infection control and stated that they have not witnessed any issues with the facility’s practices. On 01/15/25, during a facility visit, LPA Lee observed staff (S1) assisting resident (R1) with a transfer while wearing gloves, and then washing hands afterward. Based on the interviews and observations made throughout the investigation, LPA Lee was unable to corroborate the allegations. 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. An exit interview was conducted and a copy of this LIC 9099, report was provided to facility.the state’s words, verbatim · CDSS document, Feb 4, 2025 · control 27-AS-20241126140608

Type of visit: Required - 1 Year

On 11/7/24 at 1:45pm Licensing Program Analyst (LPA) Kevin Gould arrived at Camelot Care Bucks Harbor for the purpose of conducting a required 1 year annual inspection. LPA met with staff, Jane Aragon and together conducted a tour of the home. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 104.5 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. LPA observed the facility is not in compliance with fire clearance as they currently have one resident who's physician has identified as bedridden and the facility does not have a bedridden fire clearance. LPA also observed while reviewing staff files that two of the three staff files reviewed showed staff members were short of the required 8 hours of dementia care training as LPA only observed 5 hours each. Per California Code of Regulations, Title 22 the following deficiencies are cited during today's inspection. An immediate civil penalty was issued during todays inspection. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Nov 7, 2024

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required annual inspection visit. LPA met with administrator and explained the purpose of the visit. Administrator certificate #6043428740 expires on 01/25/2023. This facility is a single story building licensed to serve six non-ambulatory residents and has a hospice waiver for two residents. LPA and staff toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms, garage and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 112.8 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher last serviced 7/6/2023. Thermostat observed at 75 degrees Fahrenheit. LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to residents. LPA reviewed three resident files and three staff files. A review of staff records indicates that all facility staff & other individuals who require caregiver background checks are fingerprint cleared and to the facility. LPA verified staff training for staff file reviews and all three staff have current First Aid Certificates. LPA requested the following updated documents to be submitted via email to community care licensing by 12/4/2023: LIC 308 - Designation of Administrator, LIC 500 - Personnel Report, copy of administrator's certificate, and liability insurance. ruth.wallace@dss.ca.gov Per the California Code of Regulations, Title 22 no deficiencies were observed or cited. Exit interview held with administrator. A report and LIC 811 (Confidential Names) was left at the facility.the state’s words, verbatim · CDSS document, Nov 16, 2023