Caring Families-Bv2

Type of visit: Required - 1 Year

On 7/15/2026, at 1:00 PM, Licensing Program Analyst (LPA) Reza Jamaly conducted an unannounced annual inspection at the facility. LPA met with Licensee/Administrator Alyssa Robinson and explained the purpose of the visit. Present during today's inspection were four (4) residents and one (1) staff member. The Administrator's Certificate expires on 8/24/2027. The facility is a single-story home located in a residential neighborhood and is licensed to serve up to six (6) elderly residents, age 60 and over. LPA inspected the living room, kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, and outdoor areas. Four (4) resident bedrooms and two (2) resident bathrooms were inspected. Resident bedrooms were observed to be adequately furnished with the required furniture. Bathrooms were equipped with grab bars and non-skid surfaces. The sinks, toilets, and showers were observed to be clean and in good working order. The indoor temperature measured 73°F, which is within the required range of 68°F to 85°F. The hot water temperature measured 119°F, which is within the required range of 105°F to 120°F. The kitchen and dining area were inspected. LPA observed at least a two-day supply of perishable food and a seven-day supply of nonperishable food, consistent with regulatory requirements. Continues on LIC 809C on page 2 page 2 The door leading from the kitchen to the laundry room was secured with a keypad lock. Inside the laundry room, medications were stored in a locked cabinet. Toxins were stored in a separate cabinet. Knives and other sharp instruments were stored in an unlocked cabinet. The Administrator stated that residents do not have access to the laundry room and that only staff members know the keypad code. LPA verified that the laundry room remained secured and could only be accessed using the keypad code. The fire extinguisher was observed and was last serviced on July 5, 2026. Two smoke detectors and one carbon monoxide detector were observed and appeared to be properly installed. An adequate supply of linens was available. The outdoor area was inspected. Walkways were free of obstructions, and the perimeter fence and gate were observed to be in good repair. No bodies of water were present on the premises. LPA requested resident and staff records for review. Three (3) of four (4) resident files were reviewed and found to be complete. Three (3) staff files were reviewed and found to contain the required documentation. The following documents were requested and are to be submitted to LPA by July 16, 2026, no later than 5:00 PM: LIC 308 – Designation of Administrative Responsibility Copy of the Administrator Certificate Proof of Current Liability Insurance LIC 500 – Personnel Report LIC 309 – Administrative Organization Based on today's inspection, the facility was found to be in compliance with applicable California Code of Regulations, Title 22 requirements. An exit interview was conducted with Licensee/Administrator Alyssa Robinson. A copy of the LIC 809, Facility Evaluation Report, was provided to the facility representative.the state’s words, verbatim · CDSS document, Jul 15, 2026

Type of visit: Required - 1 Year

On 06/11/2025 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 Alyssa Robinson the Designated Facility Administrator 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 4. LPA Hayes toured the facility with the Designated Facility Administrator (DFA), Alyssa Robinson. The kitchen was accessible to residents and clean and sanitary. The LPA observed 7 days of non-perishable and 2 days of perishable food supplies. There is enough clean plates, cups and bowls and cutlery to meet capacity. Opened packages in the refrigerator were dated appropriately. All pantry items were dated as well. Water temperature measured 105 degrees F within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire extinguishers inspected were charged on 01/22/25 by River City Fire. A smoke detector in living room was tested and and working. Carbon Monoxide detectors were present. Continued on 809-C There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secured. The medication administration record (MAR) was reviewed and found to be complete with a detailed accounting of medications that have been provided to residents. The garage is not accessible to residents and contained diaper supplies, a deep freezer and cleaning supplies. Administrator states residents cannot access the laundry room. LPA observed the backyard of the facility to be clean and free of obstruction. There are shaded areas for residents to enjoy. Fencing was in good repair. There was patio furniture, flowers and a walking path for residents. There were no bodies of water. Two first aid kits were observed containing a first aid manual, tweezers, scissors, gauze and Band-Aids. The facility living room was clean and free of obstruction. The temperature reading was 77 degrees Fahrenheit per Title 22 regulations. The seating is efficient seating for the number of residents in this facility. Per California Code of Regulations, Title 22, no deficiencies were observed during today’s visit. Exit interview was conducted. A copy of this report was provided to DFA, Alyssa Robinson.the state’s words, verbatim · CDSS document, Jun 11, 2025

Allegation investigated: Staff are not providing adequate assistance to residents while care. Staff are not meeting resident's hygiene needs. Staff are not meeting resident's nutritional needs. Staff are not meeting resident's grooming needs.

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 1/10/25 at 8:45AM to conclude the complaint investigation. LPA met with Lorrena Lopez Goodenough, Administrator and Tamara Fitzpatrick, CEO and explained the purpose of the visit. LPA interviewed resident #4 (R4-R5) and Staff #3 (S3-S4) during this visit. Regarding allegation, “Staff are not providing adequate assistance to residents while care” R1 Responsible Party stated that staff mentioned a sore on R1’s buttock. R3 Responsible Party stated that R3 loves the home, staff is good at assisting R3. R4 stated staff always assist and is much better than the last place. R5 was interviewed but may not be a credible witness due to diagnosis of dementia S1 stated assistance is provided for the care of the residents. S2 stated unannounced visits revealed the residents are well cared for. S3 stated all the residents received assistance. Unsubstantiated A review of resident #1 (R1) Resident Activities of Daily Living (ADL) Log Sheet revealed that during 5/19/24- 6/15/24, R1 weighed 92-93lbs and that ADL’s were being provided. The investigation revealed that staff used butt paste to prevent a pressure injury for R1 and interviews conducted on 6/24/24 indicate residents are receiving assistance with ADLs. The preponderance of evidence has not been met. Regarding allegation, “Staff are not meeting resident's hygiene needs” R1 Responsible Party stated that R1s teeth are never brushed. R3 Responsible Party stated a few times R3 was not smelling well upon arrival for a visit, but staff handled it. R4 stated I take care of my own as much as I can until I can't. R5 was interviewed but may not be a credible witness due to diagnosis of dementia S1 Traci stated one of the residents does hit and showers has been skipped until we can do it. R1 had a sore but cream was used on it, and R1 has dentures. S2 stated residents are on a schedule and teeth and dentures are not dirty nor neglected. S3 stated there is a shower schedule for everyone and after they get lotion. A review of resident #1 (R1) Resident Activities of Daily Living Log Sheet revealed that during 5/19/24- 6/15/24, R1 received assistance with care needs such as oral, food, liquids, shower. LPA observed on the log indicates that there were only a few instances where R1 did not either have a bowel, shower, or oral care. R1 had a dedicated shower day on Tuesday and Saturday. The investigation revealed that there is 1-2 staff on every shift and daily logs are being completed as to the hygiene practices in which staff is assisting. Interviews conducted on 6/24/24 indicate residents are receiving assistance with hygiene needs. The preponderance of evidence has not been met. Regarding allegation, “Staff are not meeting resident's nutritional needs” R1 Responsible Party stated that snacks are given. R3 Responsible Party stated that they would eat the food because it passed the taste test, and R3 loves it.R3 Rp not aware. R4 stated the food is edible and I like it. Its much better than the last place. R5 was interviewed but may not be a credible witness due to diagnosis of dementia S1 stated the food is made somewhere else and we add things like rice and vegetables. They make the main meal we add the sides. S2 stated food is cooked fresh. The food has been observed during preparation and cooking process and there is 1 cook. S3 stated R1 ate a lot even between meals. All the residents ate at the same time which was 5:30p A review of the meal menu for week 1-8 reveals that there is a variety of meals prepared for breakfast, lunch, and dinner The investigation revealed that meal main course is being cooked off site and the side items are being prepared at the facility. Interviews conducted on 6/24/24 indicate residents are receiving food of good quality and quality as well as snacks between meals. The preponderance of evidence has not been met. Regarding allegation, “Staff are not meeting resident's grooming needs” R1 Responsible Party stated that it appears that staff tends to residents grooming needs. R3 Rp stated there is no issue now but in 2023 it was but only that 1 time. R4 stated the food is edible and I like it. Its much better than the last place. R5 was interviewed but may not be a credible witness due to diagnosis of dementia S1 stated residents’ teeth are brushed and R1 has dentures. There is one resident who doesn’t like it much. S2 stated residents have shower schedules dressed and hair is brushed. Staff allow residents to do ADLs with assistance. When they refuse, there is an attempt to try again by another staff but never forced. Residents are not left with only a depend on without any other clothing. S3 stated teeth were cleaned and dentures were put into a cup to be cleaned. A review of resident #1 (R1) Resident Activities of Daily Living Log Sheet revealed that during 5/19/24- 6/15/24, R1 received assistance with care needs and R1 had a dedicated shower day on Tuesday and Saturday. The investigation revealed that residents are receiving assistance with brushing their teeth and/or dentures when allowed by the residents. Interviews conducted on 6/24/24 and 1/10/25 indicate residents are receiving assistance with ADLs. The preponderance of evidence has not been met. Based on interviews conducted on 6/24/24 and records review, it was determined that the preponderance of evidence standard is not met, therefore the allegation is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged incident occurred. 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, Jan 10, 2025 · control 27-AS-20240613130943

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 5/13/24 at 9:00am. LPA met with Lorrena M Goodenough, Administrator and stated the purpose of todays visit. LPA observed the Administrator Certificate for Lorrena M Goodenough expires 1/29/25 and for Michelle R Macias 7/4/24. License fees are current. The most current emergency drill was conducted on 3/29/24. The facility is licensed for a capacity of 6 non-ambulatory residents of which 2 may receive hospice care services. Facility is cleared for locked perimeter. There is 0 residents receiving hospice care services during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 77*F which is within the required range of 68-85*F. The hot water temperature was measured at 107.8*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 contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA reviewed 1 staff and 3 resident files and conducted interviews during this visit. 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 Emergency Disaster Plan LIC610E-Submit 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 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-Submit Infection Control Plan-Submit 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, May 13, 2024