Caring Hearts Senior Care Home

Type of visit: Required - 1 Year

On 12/16/2025 at 1:40 p.m., Licensing Program Analyst (LPA) Evelin Rios arrived to this facility to conduct an unannounced, annual inspection. LPA was greeted by Staff #1(S1), who granted access. S1 contacted the administrator, Marita Amorsolo-Samaniego. Another staff, Staff #2 (S2) was observed by LPA in the facility assisting residents. The administrator and designee, Tatiana Buendia arrived shortly after. The administrator could not stay for the duration of the visit and designated, Tatiana to sign todays report. By the entrance LPA observed that the facility had required postings, which include but are not limited to the Complaint Poster, Long-Term Care Ombudsman information, and Residents' Rights. At approximately 2:00 p.m., LPA conducted an inspection of the facility inside and out and the following was observed: Common Areas: These include the sitting area at the front of the facility, and the living/dining area. The sitting area, living/dining area were clean and clear of clutter, furnished appropriately and sit the capacity of the facility. The furniture was observed to be in good repair. Bedrooms: There are five (5) bedrooms designated for residents. One (1) bedroom is shared. LPA observed each resident room to be properly furnished and have sufficient storage. Exit doors had auditory alarms that were on and observed functioning. The facility is equipped with hardwired smoke and carbon monoxide detectors through out the facility. LPA observed S2 test detectors at approximately 2:11 p.m. and were observed to be functioning. (Continued on LIC809-C) (Continued from LIC809)Bathrooms: The facility has three (3) bathrooms, two of which are designated for resident use, and one is located in the shared bedroom for private use. Bathrooms were properly supplied with hand soap, toilet paper and paper towels. Hot water temperature in the bathrooms were tested at 2:16 p.m. and measured around 116.8 degrees Fahrenheit. Laundry Room: The laundry room was observed locked. Cleaning supplies and detergents were observed locked in cabinets in the laundry room. Kitchen: The kitchen was observed clean and clear of clutter. Fixtures and appliances were observed functional. LPA observed a sufficient amount of 2-days perishable and 7-days non-perishable food in the facility. Food was observed stored in covered containers at appropriate temperatures. Knives were observed locked in a kitchen drawer. Centrally stored medication was observed locked in a kitchen cabinet. A fully charged fire extinguisher was observed on a kitchen wall with purchase date 03/19/2024. LPA observed a fully stocked first aid kit and manual accessible to staff in the kitchen. Surrounding Grounds: Backyard space was large enough for outdoor activities. The backyard is fully fenced in and no hazards observed. No body of waters observed. Client/Staff Records: At approximately 3:00 p.m., LPA reviewed the facility’s file, as well as resident and staff records, to assess compliance with required licensing documentation. Facility’s file, included the but not limited to, resident roster, personnel report, liability insurance certificate, emergency and disaster plans, and documentation of emergency drills conducted by the facility. At approximately 3:17 p.m., LPA reviewed five (5) resident records and three (3) staff records. During the review of Resident #1’s (R1) Physician’s Report, LPA observed that TB test results were not documented. According to designee the facility is awaiting a mobile lab to schedule an in-home TB test for R1. No documentation of TB test results was found in R1’s file at the time of the visit. Deficiency observed during the visit (refer to LIC809-D). Appeal Rights Provided. Exit Interview conducted. A copy of the report issued.the state’s words, verbatim · CDSS document, Dec 16, 2025

Allegation investigated: Staff did not ensure facility had adequate staffing to meet resident's needs.

On 04/28/2025 at 3:20 p.m., Licensing Program Analyst (LPA) Evelin Rios arrived at this facility to conduct an unannounced, subsequent visit to deliver findings on the above allegations. Upon arrival, LPA met with staff and requested they contact the administrator. Staff contacted the administrator, Marita Samaniego. At approximately 3:23 p.m., LPA met with the Administrator, LPA Rios conducted a physical plant tour to ensure the health and saftey of the residents in care. No issues observed. To investigate the allegations LPA Rios conducted an initial visit on 3/11/2025 and obtained a copy of the resident roster, personnel report (LIC500), and staff schedule. On 3/11/2025 the administrator assistant informed LPA, one (1) resident was at the hospital and the LIC500 needed to be updated to include two new permanent staff and one on-call staff. On 3/11/2025 from approximately 11:40 a.m. to 12:20 p.m., LPA conducted interviews with three (3) out of six (6) current residents. Resident #1 (R1) is no longer in the facility. (Continue to LIC9099-C) Substantiated (Continued from LIC9099) The three (3) residents not interviewed were sleeping, at the hospital, or did not respond to LPA's questions. On 3/11/2025 from approximately 12:20 p.m. to 12:50 p.m., LPA conducted interviews with two (2) staff present and the assistant administrator. On 3/11/2025 from 12:50 p.m. to 1:45 LPA reviewed resident and staff records and obtained copies of residents’ Physician's Reports (LIC602A) and Appraisal / Needs and Services Plan (LIC625). Allegation: Staff did not ensure facility had adequate staffing to meet resident's needs. Regarding the allegation, it was reported there is no overnight staff. To investigate the allegation LPA Rios conducted an initial visit on 3/11/2025. LPA's review of the facility's LIC500 revealed most shifts are from “7AM” to “7PM” with no overnight shift. The staff monthly schedule reveled two staff names on each day for this facility. The staff monthly schedule does not have which hours the staff member is covering. The assistant administrator admitted not verbatim that prior to three (3) weeks ago they did not have an overnight staff on schedule so relied on live-in staff to wake up and provide assistance when needed. Staff corroborated that there was no overnight staff assigned to provide care; however, staff would wake up if needed to assist residents with agitation, wandering, or incontinence needs. Staff interviews revealed that there is now one (1) awake staff member overnight to check on residents. LPA's review of facility's program under Basic Services states verbatim "Checks will be made on a regular basis, including night time. Patterns of incontinence will be discussed with physician. Night time, awake staff will be employed as necessary." Based on interviews and record review the allegation is deemed Substantiated. Deficiency cited (refer to LIC9099-D). Exit interview conducted. Copy of report provided. (Continued from LIC9099-A) The three (3) residents not interviewed were sleeping, at the hospital, or did not respond to LPA's questions. On 3/11/2025 from approximately 12:20 p.m. to 12:50 p.m., LPA conducted interviews with two (2) staff present and the assistant administrator. On 3/11/2025 from 12:50 p.m. to 1:45 LPA reviewed resident and staff records and obtained copies of residents’ Physician's Reports (LIC602A) and Appraisal / Needs and Services Plan (LIC625). Allegation: Staff left resident soiled for an extended period of time. Allegation: Staff did not respond to resident's call button in a timely manner. Regarding the allegations, it was reported that Resident #1 (R1) requested toileting assistance around 3:00 a.m. but did not receive timely attention, resulting in being left in soiled undergarments. LPA's interview with the assistant administrator revealed that a complaint had been received by the facility a few weeks ago from a resident's family member about how staff treated the resident. According to the assistant administrator, Staff #1 (S1) and Staff #2 (S2) were let go as a precaution based on the statements made by the family. LPA's review of residents’ LIC602 and LIC625 revealed resident have bowel and bladder impairment. LPAs interview with staff on 3/11/2025, corroborates all current residents require incontinence care. The assistant administrator admitted not verbatim that prior to three (3) weeks ago they did not have an overnight staff on schedule so relied on live-in staff to wake up and provide assistance when needed. Staff corroborated that there was no overnight staff assigned to provide care; however, staff would wake up if needed to assist residents with agitation, wandering, or incontinence needs. Staff interviews revealed that there is now one (1) awake staff member overnight to check on residents. LPAs interview with staff on 3/11/2025 deny witnessing residents in soiled diapers from the previous shift or not attending to residents timely except for when they were assisting another resident in which case they would excuse themselves to check on the resident that was calling for assistance. LPA's interview with three (3) current residents revealed that wait times do vary not specific to the time of day but that they have no concerns about the wait time. Based on interviews and record review the allegations are unsubstantiated. Exit Interview. Copy of report provided.the state’s words, verbatim · CDSS document, Apr 28, 2025 · control 31-AS-20250306131914

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a) · Plan of correction due date: May 9, 2025

87208 (a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation...This requirement is not met as evidenced by: Based on interviews, and record review Licensee failed to schedule an awake night staff as necessary which posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 28, 2025

Plan of correction: Licensee has scheduled awake staff at night to check on residents' needs. Licensee will provide LPA an updated LIC 500, a statement of understanding regarding the regulation cited. With the statement of understanding Licensee will include that they have reviewed facility's program regarding Basic Services and Supplemental Information to Provide Care for Persons with Dementia. POC due by 05/09/25.

Allegation investigated: Staff yelled at resident.

On 03/11/2025 at 11:00 a.m., Licensing Program Analyst (LPA) Evelin Rios arrived to this facility to conduct an unannounced, initial complaint visit. Upon arrival, LPA met with staff and requested they contact the administrator. Staff contacted the administrator. At approximately 11:15 am., LPA met with the Assistant Administrator Lily Anne Gagarin. According to Lily Anne the administrator is unavailable today. Lily Anne will be signing today's report. Allegation: Staff yelled at resident. In regards to the allegation is was reported that a male staff in a raised angered voice scolded resident #1(R1). To investigate the allegation at 11:18 a.m. LPA requested a copy of the resident roster, personnel report (LIC500), and staff schedule. According to the assistant administrator, one (1) resident is currently hospitalized and the LIC 500 needs to be updated to include two new permanent staff and one on call staff. At approximately 11:25 a.m., LPA conducted a physical plant tour of the facility to ensure the health and safety of the residents in care. (Continue to LIC9099-C) Unsubstantiated (Continued form LIC 9099) From approximately 11:40 a.m. to 12:20 p.m., LPA conducted interviews with three (3) out of six (6) current residents. R1 is no longer in the facility. The three (3) residents not interviewed were sleeping, at the hospital, or did not respond to LPA's questions. From approximately 12:20 p.m to 12:50 p.m., LPA conducted interviews with two (2) staff present and the assistant administrator. From 12:50 p.m. to 1:45 LPA reviewed resident and staff records and requested copies of residents Physician's Reports (LIC602A) and Appraisal / Needs and Services Plan (LIC625). LPA's interview with staff revealed they have never witnessed staff yelling at residents and deny they have yelled or raised their voice at residents. LPA's interview with three (3) out of the three (3) residents that were interviewed deny staff yelling at them. Interview with Two (2) out of the three (3) residents interviewed deny witnessing staff yell at other residents. LPA's interview with one (1) out of the three (3) residents revealed they have heard a "female" voice yell but did not recall if it was towards another resident, when it had occurred or what time of day it happened. LPA's interview with the assistant administrator revealed they had received a complaint a few weeks ago form a resident's family member about how staff treated the resident. According to the assistant administrator staff #1 (S1) and staff #2 (S2) were let go as a precaution and for not providing assistance. The assistant manger also informed LPA they do not believe S2 had yelled at R1 but that S2 has a "managerial" voice in general and that it may have been misinterpreted as yelling. LPA was unable to corroborate allegation. Although the allegation may have happened or is valid, there is not enough evidence to prove the alleged violation did or did not occur. Therefore, the allegation is Unsubstantiated. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Mar 11, 2025 · control 31-AS-20250306131914

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 11/22/2024 at 8:40 a.m., Licensing Program Analyst (LPA) Evelin Rios arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA met with Jezrael "Jesse" Teriote, and explained the purpose of the visit. Jesse requested LPA sign in and then contacted the administrator, Marita Samaniego. According to Jesse the administrator may meet LPA later, but was currently attending training. The facility is a licensed Residential Care Facility for the Elderly (RCFE), with a capacity of six (6) non-ambulatory residents of which one (1) may be bedridden. The facility also has a Hospice waiver for two (2) residents. Required postings were observed upon entry. At approximately 8:45 a.m., with the assistance of staff, LPA took a tour of the physical plant and the following was observed: Common Areas: These included the sitting area, living room and dining area. The sitting area was clean and clear of clutter, furnished with couches and chairs to sit the capacity of the facility. The living room is furnished with couches, recliners, a television and fireplace secured with a screen. The dining room has a table with chairs large enough to seat six (6) comfortably. Furniture was observed to be in good repair. Hallways, entry and exits were clear of any obstructions. Kitchen: The kitchen was observed to have a refrigerator, stove/oven, dishwasher and microwave. Fixtures and appliances were observed functional. LPA observed a sufficient amount of 2-days perishable and 7 -days non-perishable food in the facility; properly stored. Knives were observed locked in a kitchen drawer. Centrally stored medication was observed locked in a kitchen cabinet. A fully charged fire extinguisher was observed on a kitchen wall with purchase date 03/04/2024. Medication requiring refrigeration was observed in a locked box in the fridge. LPA observed a fully stocked first aid kit and manual accessible to staff in the kitchen. (Continued on LIC809-C) Bedrooms: There are five (5) total resident bedrooms of which one (1) may be shared. LPA observed each resident room to be properly furnished with appropriate beddings and linens and sufficient lighting. Exit doors had auditory alarms that were observed functioning. Bathrooms: The facility has three bathrooms with walk-in showers. Bathrooms were properly supplied with hand soap, toilet paper and paper towels. Hot water temperature in the bathrooms were tested at 9:00 a.m. and measured 116 degrees Fahrenheit, within regulation. The facility is equipped with hardwired smoke and carbon monoxide detectors through out the facility. LPA observed staff test alarms at approximately 9:05 a.m. and were observed to be functioning. Surrounding Grounds: Backyard space was large enough for outdoor activities. There is a covered patio with outdoor furniture. A shed used for extra facility storage was observed locked. The gates on both sides of the home were checked to insure no locks were installed, and that exits and passageways were clear for emergency evacuation. Laundry Room: The laundry room was observed locked and leads to staff bedrooms. Cleaning supplies and detergents were locked in cabinets and in the laundry room. Client/Staff Records: At approximately 9:30 a.m, facility, resident and and staff records were reviewed to insure compliance. LPA reviewed resident roster, personnel report, liability insurance certificate, infection control plan, emergency and disaster plans and drills. At 10:21 a.m. LPA reviewed four (4) of four (4) resident records and three (3) staff records. Medications: At 11:20 a.m. LPA reviewed medication and Centrally Stored Medication Destruction Records for compliance. LPA spoke to Administrator, Marita Samaniego by telephone. Marita designated Jesse to sign today's report. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted. A Copy of the report issued.the state’s words, verbatim · CDSS document, Nov 22, 2024