Caring Hands Residential Living II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Staff S1 Abijuan Burchell. During the visit, LPA observed 3 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 2 restrooms and 4 residents bedrooms. There was no obstruction to block the walkways. The staff area of the facility was also inspected. The front yard and backyard were inspected. LPA toured resident bedroom #5. LPA observed on the cabinet next to R1's bed contained a medication. LPA reviewed R1's Physician's Report dated April 22, 2021, states R1 cannot administer and/or store his/her own medications. While touring bedroom #4, LPA observed frame missing from the door. LPA toured bedroom #2, and observed a hole, in the wall. This whole matches the path of the door for bedroom #2 opening. LPA also observed damage to the door frame in bathroom #2. LPA also observed the sliding door screen for bedroom #5 was not attached. LPA toured the backyard of the facility. LPA observed leaves and multiple fruits in the ground, directly across from bedrooms 2 & 3, and the patio. Page 1 Out of 3 Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 119 degrees F in resident bathrooms. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on October 10, 2025. LPA reviewed facility records for 3 staff and 3 residents. LPA noted that R1's Physician's report is dated April 22, 2021. LPA requested to review documentation demonstrating the Administrator requested an updated physician's report from the resident and/or the residents representative. The Administrator also did not provide any documentation showing that R1 or R1's representative had reused to receive annual assessment for an updated physician's report. LPA requested to review Staff S2's LIC501, LIC503 and documentation of training. LPA was not provided the following but not limited to documents regarding S2 to review/inspect : LIC501, Staff training records, LIC503. LPA reviewed 3 resident medications and centrally stored medication records. Resident R1 and R2's Centrally stored medication Record forms only has medications with start dates from the year 2024. LPA asked S1 for the most current forms for R1 and R2. S1 stated they only fill out the centrally stored medication records once a year. LPA informed S1 that the centrally stored medication record must be updated continuously. The record must be updated every time a new medication has been prescribed by the residents doctor. Page 2 Out of 3. The Department is issuing an immediate civil penalty of $250 for each repeat violation for the following deficiencies: 87463 Reappraisals (h), which was previously cited on January 16, 2025 Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D. This report was reviewed with Staff Abijuan Burchell and a copy of the report was provided. Appeal Rights was provided. Page 3 Out of 3. End of Reportthe state’s words, verbatim · CDSS document, Jan 8, 2026

Type of visit: Case Management - Other

On August 19, 2025, licensing Program Analyst Manuel Monter conducted an unannounced Case Management- Other visit. LPA met with Staff (S1)Abijuan Burchell. LPA explained the purpose of the visit. On January 16, 2025, LPA Manuel Monter conducted an annual inspection at the facility. During the inspection, deficiencies were noted and cited. Due to repeat violations for deficiencies under the same code section, the Department issued immediate civil penalties. The Department issued immediate civil penalty of $250 for each repeat violation for the following deficiencies on January 17, 2025: 87309 Storage Space & Access (a), which was previously cited on January 25, 2024. 87463 Reappraisals (a), which was previously cited on January 25, 2024. HSC 1569.695(c), which was previously cited on January 25, 2024. During todays visit, LPA had delivered Invoice Notice of civil Penalties Due (LIC 422 DASB) LPA explained to ADM, that failure to pay civil penalty may result in any or all of the following Seizure of personal income tax refunds License Denial, Suspension or Revocation Court Action No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with ADM Sylvester Okoro, via Phone call, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 19, 2025

Type of visit: Case Management - Deficiencies

On March 21, 2025, Licensing Program Analyst Manuel Monter conducted an unannounced Case Management - Deficiencies visit. LPA met with Staff S1 Abijuan Burchell. LPA explained the purpose of the visit. On January 16, 2025, the facility was cited the following type A deficiency, during an annual inspection, with the POC due of January 17, 2025. -- 87309 Storage Space and Access (a) On January 17, 2025, the Department received plan of corrections and cleared plan of corrections on January 17, 2025. On March 21, 2025, LPA conducted a follow up visit. LPA toured the facility inside and out. LPA did not observe any detergents or toxics accessible to residents in care. LPA observed the storage shed in the backyard locked. While touring the home, LPA observed the door in the living room had a Tuut door lever lock, child proofing door handle, creating an obstruction to opening that door. (Photograph was taken). While touring the facility kitchen LPA observed the glass sliding screen door. LPA observed a stick blocking the path of the sliding screen door, creating an obstruction. (Photographs were taken.) A deficiency is being cited during today's visit. This report was reviewed with Staff Abijuan Burchell and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Mar 21, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(d)(6) · Plan of correction due date: Mar 22, 2025

87307 Personal Accommodations and Services(d) (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement was not met as evidenced by: Based on observation, facility's kitchen, sliding screen door has a stick preventing the door from opening. LPA observed the door in the living room had a Tuut door lever lock creating an obstruction to opening that door. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 21, 2025

Plan of correction: ADM stated he will send a letter of understanding regarding the regulation. ADM stated he will send photo documentation showing both the Tuut door lever lock, child proofing door handle and the stick in the kitchen have been removed. ADM stated he will send the plan of corrections to LPA by POC date, March 22, 2025.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Staff Abijuan Burchell. During the visit, LPA observed 3 residents and 2 staff. LPA explained the purpose of the visit. Staff S1 contacted ADM at 2:02pm. LPA informed ADM, via phone call, that LPA was conducting their annual inspection. ADM stated he could not come to the facility and stated staff S1 could sign on his behalf. LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 2 restrooms and 5 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. While touring the facility garage, LPA observed the door which leads to the garage does not have a locking mechanism. (Photograph was taken.) LPA observed the facility garage has an assortment of detergents and other cleaning liquids and sprays on the ground, accessible to residents in care. (Photographs were taken.) While touring the backyard, LPA observed a storage shed in the backyard. LPA asked S1 to open the storage shed. S1 informed LPA the storage shed does not have a lock. LPA observed inside the storage shed, a container of gasoline, paint and other tools. LPA opened container of gasoline and confirmed the container had gasoline liquid inside. (Photograph was taken.) Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area as locked and inaccessible to residents in care. Room temperature was at 76 degrees F, and hot water temperature was measured to range from 116-118 degrees F in both resident bathrooms. Page 1 Out of 3 Fire extinguisher was serviced in October 16, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility conducted drills for the year 2024, for the following dates; August 30, 2024, May 31, 2024, and February 18, 2024. LPA asked S1 if a drill had been conducted From September 2024 - January 2025. S1 stated she believes a drill was conducted in November, but it wasn't written down. Staff was unable to produce documentation a drill had taken place in the 4th quarter of 2024. LPA reviewed facility records for 3 residents. LPA requested to review R1's needs and Services plan (ANS). Based on a review of R1's ANS, the form is blank, only containing the facility's information, the residents name, and dated December 2024. (Photographs were taken). S1 stated the facility was in the process of filling out R1's ANS. LPA reviewed R3's physician report dated, September 9, 2020. LPA requested to review R3's updated physicians report. Facility staff was unable to produce a copy of an updated physicians report or documentation showing the administrator contacted the residents responsible party to get an updated physicians report. LPA requested to review a copy of R3's needs and services plan. S1 stated ADM sent her a copy. S1 provided LPA with a Needs and Services plan for the facility, "Hearts and Minds Activity Center." LPA requested to review R4's physicians report and Needs and services Plan. S1 stated those are the forms the facility is still working on filling out. S1 stated R4 has not had a medical assessment yet. LPA was not provided a copy of R4's needs and services plan or physicians report. Page 2 Out of 3. LPA reviewed facility records for 3 staff. LPA requested to review staff S1's training for 2024. S1 stated she did not complete any training for 2024. LPA reviewed 3 resident medications and centrally stored medication records. While reviewing resident R1-R4's Centrally stored medication records, LPA observed R1,R2 & R4's Centrally stored medication log was not filled out. S1 stated they have not filled out their centrally stored medication record. LPA observed Resident R3's centrally stored medication record had several medications that were not listed and had incorrect information, such as the incorrect prescribing physician. (Photographs were taken.) The Department is issuing an immediate civil penalty of $250 for each repeat violation for the following deficiencies: 87309 Storage Space & Access (a), which was previously cited on January 25, 2024. 87463 Reappraisals (a), which was previously cited on January 25, 2024. HSC 1569.695(c), which was previously cited on January 25, 2024. Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D. This report was reviewed with Staff Abijuan Burchell and a copy of the report was provided. Appeal Rights was provided. Page 3 Out of 3. End of Reportthe state’s words, verbatim · CDSS document, Jan 16, 2025

Type of visit: Case Management - Other

On January 25, 2024 Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced Case Management visit and met with Staff Member (S1) Abijuan Burchell. S1 called Administrator Sylvester Okoro. LPA explained to the ADM and S1 the purpose of the visit was to hand deliver a letter of exclusion for staff S2. Staff S2 was not in the facility during LPA's visit. ADM stated S2 never worked at the facility. A sealed letter with S2's exclusion letter was delivered. LPA requested an updated LIC500, to be submitted by January 26, 2024 No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Staff Member (S1) Abijuan Burchell and ADM Sylvester Okoro, via phone call, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 25, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Staff Member (S1) Abijuan Burchell . During visit, LPA observed 2 residents and 1 staff. S1 called Administrator Sylvester Okoro, via phone, and informed the ADM the purpose of the visit. LPA toured the facility inside out with S1 which included; the Living room, kitchen, 2 restrooms and 5 residents bedrooms. While touring the restrooms, LPA observed a bottle of Lysol all purpose cleaner in the private bathroom, in resident bedroom #2. (photograph was taken). LPA also observed shower curtain rod in the private bathroom was laying on the side, in resident bedroom #2. The shower in the private bathroom, for resident bedroom #2 does not have an attached shower curtain. (photograph was taken. ) LPA observed the private bathroom for Resident bedroom #2 does not have a non-skid mat. While touring the bedrooms, LPA observed an indentation in the hallway opening to bedroom 4 & 5. The indentation can is located on the hardwood floor, with grey duct tape. Resident bedroom #5 is a non ambulatory room. S1 opened the living room closet, and the doors hinges on the top were not attached. When S1 attempted to close the closet door, he/she needed to lift the door. (photographs were taken.) Front yard and backyard were inspected. While touring the backyard of the facility, LPA observed a can of "Henry-Wet patch, roof leak repair", directly outside Room #3's window. (Photograph was taken.) LPA also observed bedroom #4 does not have a sliding screen for the door facing the patio. LPA observed bedroom #3's window screen was not attached and had an opening. LPA observed bedroom #2's sliding screen door was missing as well. LPA observed a sliding screen on top of a table in the patio. (Photographs were taken.) There was no obstruction to block the walkways. Page 1 out of 3 Two day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication closet, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 73 degrees F, and hot water temperature was measured at 115 degrees F in both resident bathrooms. Fire extinguisher was serviced in October 25, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on August 23, 2023. LPA reviewed facility records for 3 residents. While reviewing R1's Needs and services plan, dated April 23, 2021, the form is blank under socialization, emotional, mental, physical, functioning needs. A review of R1's physician report, dated April 22, 2021, states R1 is non ambulatory, and "needs assistance while in bed, as needed during the day while up." According to Title 22 code of regulations, 87705 Care of Persons with Dementia (c)(5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. While reviewing R2's file, LPA observed R2's physicians report, dated, September 9, 2020. The physician report states R2 has a neurocognitive disorder. LPA reviewed Resident R3 file. LPA observed R3's physicians report, dated November 29, 2022. R3's physician report states R3 has a neurocognitive disorder. R3's Needs and services plan is dated December 23, 2022. LPA asked S1 if there was an updated physician report for R2 and R3. S1 stated what's in the file is what the facility had. LPA reviewed 3 resident medications and centrally stored medication records. While reviewing R1's medication's, LPA observed over 2 dozen medications, not secured in their container. (photograph was taken) LPA conducted interviews with 1 staff (S1) and 2 residents (R1-R2). Page 2 out of 3. LPA requested to review 3 staff files. S1 provided 1 staff file. LPA requested to see 2 additional files. S1 stated that was the only one in the facility. S1 called ADM at approximately 1:07pm. S1 stated he/she spoke with ADM. S1 stated there are no other staff files in the facility. S1 stated the other staff files are in the other home. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. Exit interview was conducted with ADM at approximately 3:04pm and stated Staff Member Abijuan Burchell could sign on his behalf and a copy of the signed report & appeal rights were provided. Page 2 out of 2. Page 3 out of 3.the state’s words, verbatim · CDSS document, Jan 25, 2024