Caring Hearts Elderly Home

Type of visit: Required - 1 Year

On 10/30/25 at 12:15PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with administrator (ADM) and explained the purpose of the visit. LPA observed ADM has current RCFE administrator certificate# 6070341740 which expires 06/27/26. At 12:30PM, LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizers were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 75 deg F. Hot water temperature was measured at 112 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. Fire extinguisher was observed fully charged and purchased on 10/30/25. LPA reviewed 2 staff and 5 resident files. Continued on next page, LIC 809-C Updated copies of the following documents were collected for facility file:  LIC500- Personnel Report  Resident Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance No deficiencies observed during visit. Exit interview conducted a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 30, 2025

Allegation investigated: Resident eloped due to lack of care or supervision from staff

On 03/27/25 at 3PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with staff (S3) and spoke with administrator (ADM) on the phone who authorized S3 to act on her behalf and sign the reports. LPA gathered information on the allegations and delivered investigation finding to S3. LPA explained the purpose of the visit with ADM and S3. During investigation, the department obtained the following documents from administrator – personnel record (LIC500), residents’ roster, admission agreement, physician's report, re-appraisals and incident report. Continued on next page, LIC 9099-C Substantiated ALLEGATION: Resident eloped due to lack of supervision from staff INVESTIGATION FINDING: Substantiated During investigation, the department conducted interviews of facility staff (S1, S2), reporting party (RP) and reviewed resident (R1) documents. On 03/24/25, LPA interviewed reporting party (RP) who stated that a neighbor approached him on 03/23/25 around 02:14PM and informed him that a resident (R1) knocked on their door and told them to contact the police because her home is being invaded. RP stated that it was known to the neighbors that the facility cares for elderly residents. The neighbor walked over to the care home and explained the situation with staff (S1, S2) who were completely unaware that anyone from the facility was missing or has left the home. LPA interviewed S1 who confirmed that they did not know that R1 left the facility on 03/23/25 until the neighbor knocked on the door and told them R1 was at his home. RP stated the neighbor brought R1 safely back to the facility around 3PM. Based on observations and interviews which were conducted and record review(s), the department has substantiated the allegation that resident eloped due to lack of supervision from staff. The preponderance of evidence standard has been met. Therefore, the above allegation was found to be substantiated. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 27, 2025 · control 15-AS-20250325090010

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Apr 18, 2025

To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by neglect/lack of supervision of resident that eloped without their knowledge which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 27, 2025

Plan of correction: By POC due date, ADM agrees to complete and submit in-service staff retraining certifications on residents’ personal rights in compliance with Section 87468.2 (a)(4).

Type of visit: Case Management - Incident

On 03/27/25 at 3PM, while at the facility for another reason, LPA spoke with staff (ADM, S3) to discuss resident's (R1) elopement on 03/23/25. LPA confirmed with staff that R1's elopement incident was not reported to Community Care Licensing, the Ombudsman and police department. S1 stated he did not let the administrator know about the incident because R1 was only gone for a few minutes and returned safely back to the facility. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 27, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Apr 18, 2025

Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidenced by resident eloping without staff knowledge which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 27, 2025

Plan of correction: Administrator agreed to complete and submit in-service staff re-training on reporting requirements by POC due date in compliance with Section 87211(a)(1)(D) regulations.

Allegation investigated: Staff failed to provide a regular bed to resident in care upon admission Licensee did not provide a refund upon resident's death

On 02/27/25 at 12:30PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with administrator (ADM), gathered information on the allegations and delivered investigation findings to ADM. LPA explained the purpose of the visit with ADM. During investigation, the department obtained the following documents from administrator – personnel record, residents’ roster, admission agreement, physician’s report, pre-placement appraisal, progress notes, hospital discharge report, medication administration records. Continued on next page, LIC 9099-C Unsubstantiated Allegation: Staff failed to provide a regular bed to resident in care upon admission Finding: Unsubstantiated During investigation, LPA interviewed staff (ADM) who stated that resident (R1) and responsible party (POA) toured the facility on 12/02/24 and 01/08/25 and paid $1K to hold bedroom# 3 for R1. LPA reviewed photos of bedroom# 3 taken by ADM on 01/08/25 which showed a dresser, chair and bed inside. ADM stated that POA requested the bed and chair removed because they are of no use to R1 due to his health condition. POA delivered R1’s recliner chair and purchased a new bed which was supposed to be delivered to the facility on 01/17/25 but ended up being delivered on 01/28/25. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that staff failed to provide a regular bed to resident in care upon admission was found to be unsubstantiated. Allegation: Licensee did not provide a refund upon resident’s death Finding: Unsubstantiated During investigation. LPA interviewed staff (ADM, S1) and reviewed former resident’s (R1’s)/responsible party’s (POAs) documents. Review of R1’s documents showed that R1 moved into the facility on 01/22/25, was admitted to the hospital on 01/27/25 and returned to the facility on 01/29/25 where he passed away a few hours later. POA stated they collected R1’s personal belongings on 01/30/25. POA stated that a total advance payment of $8K was given to ADM on 01/22/25 for January move-in and February advance payment of $6K. POA sent ADM an email dated 01/30/25 requesting refund of $6K February advance payment and compensation for new hospital bed purchased ($1300). On 02/05/25, ADM agreed to refund POA the February advance payment of $6K but did not compensate for the new hospital bed. On 02/06/25, POA donated R1’s new hospital bed, electric recliner, chair covers, diapers, pads, case of Ensure and beddings to the facility. On 02/22/25, R1’s family picked up the $6K refund check from ADM for February advance payment. LPA reviewed total amount paid ($8K) by POA and determined that ADM still owes POA a total of $312 as final reimbursement of advance payment made ($2K minus $1688 equals $312). ADM issued a check of $312 to POA on 02/27/25. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that licensee did not provide a refund upon resident’s death was found to be unsubstantiated. No deficiency cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 27, 2025 · control 15-AS-20250224150432

Type of visit: Required - 1 Year

On 11/27/24 at 11AM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with manager on duty (S1) who was authorized by administrator to act on her behalf and sign the reports. LPA explained the purpose of the visit with S1. At 12PM, LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizers were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 74 deg F. Hot water temperature was measured at 107 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. Fire extinguisher was observed fully charged and purchased on 10/29/24. LPA reviewed 5 staff and 5 resident files. Continued on next page, LIC 809-C Updated copies of the following documents were collected for facility file:  LIC500- Personnel Report  Resident Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance No deficiencies observed during visit. Exit interview conducted a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 27, 2024

Allegation investigated: Staff working at the facility not fingerprint cleared

On 12/15/23 at 12:30 PM, Licensing Program Analyst (LPA) Daisy Panlilio arrived unannounced to conduct an initial 10-day complaint investigation, met with administrator (ADM), gathered information and delivered investigation finding. LPA explained the purpose of the visit with ADM. During investigation, LPA obtained the following documents from ADM: Personnel record, staff (S1) criminal record statement (LIC 508), request for live scan service (LIC 9182) and association documents. LPA reviewed staff's (S1) Guardian background check system which showed S1 was associated to the facility on 09/07/23. Continued on next page, LIC 9099-C Unfounded This department had investigated the complaint alleging that staff working at the facility is not fingerprint cleared. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint. No deficiencies cited. Exit Interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 15, 2023 · control 15-AS-20231208160215

Type of visit: Required - 1 Year

On 09/29/23 at 10AM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with manager on duty (MOD) who was authorized by administrator to act on her behalf and signe the reports. LPA explained the purpose of the visit with MOD. LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizers were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 73 deg F. Hot water temperature was measured at 118 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. Fire extinguisher was observed fully charged. LPA reviewed 5 staff and 5 resident files. LPA also conducted 2 staff and 2 resident interviews during visit. LPA observed the following deficiency during visit: Expired fire extinguisher (last purchased 11/2021) Continued on next page, LIC 9099-C Updated copies of the following documents were collected for facility file:  LIC500- Personnel Report  Resident Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance Deficiency is cited per Title 22 California Code of Regulations and listed on LIC 9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 29, 2023