Carmelo Park

Type of visit: Required - 1 Year

On 04/23/2026, Licensing Program Analyst (LPA) V Gorban arrived at the facility unannounced to conduct Required Annual Inspection. LPA met with Administrator (AD) Karie Mazerik, certification number 7008733740 and expiration date 11/13/2025. LPA conducted tour inside and out of facility with AD. Residents observed at the facility participating in activities. The facility is constructed on a slope so each floor opens directly to the ground on one side. What appears as the first floor on the uphill side becomes the second or the third floor on the downhill side. The building with capacity for forty beds; On upper level 5 rooms, second level 7 rooms, and on third 8 rooms. All rooms are double occupancy. The facility observed a comfortable temperature of 74 degrees, clean, in good repair, and no passageway obstructions or fire hazards observed. Fire extinguisher was observed with a service date of 05/01/2025 Dining area and Kitchen were toured. An adequate supply of perishable and non-perishable food was observed to be properly stored in freezer, refrigerator, and pantry. Food is delivered twice a week on Tuesdays and Thursdays. Refrigerator temperature was maintained at 33-degree F. and freezer was maintained at -3-degree F. LPA toured resident bedrooms. Residents' rooms were toured and observed with adequately furnished with bed, dresser, and adequate lighting. Hot water temperature tested at 115 degrees F. LPA observed securely fastened grab bar and non-skid mat in shower area. Medications were stored in a locked medication room. Medications records were reviewed. First Aid Kit was stored in medication room and observed with all required items. LPA toured laundry room and observed chemicals were stored and locked for staff use only. Report continues on attache LIC809-C Facility courtyard was toured and observed to be free from debris. There was outdoor seating available for the residents. Facility telephone number 831-372-8082 tested and observed operational. A count of residents and staff files were reviewed to have updated required information. Requested records attached below: Residential Care Facility for the Elderly (RCFE): · LIC 500 Personnel Report · LIC 9020 Register of Facility Clients/Residents Please submit the above forms/information to Fresno CCL by: 04/30/2026 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed. An exit interview was conducted with the AD. A copy of this report was given to the AD, whose signature on this form confirm receipt of these reports.the state’s words, verbatim · CDSS document, Apr 23, 2026

Allegation investigated: Resident sustained unexplained injury due to staff neglect/lack of supervision

On 02/11/2026, Licensing Program Analyst (LPA) V Gorban arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit to administrator Karie Mazerik and was granted entry. During the course of the investigation, LPA conducted a facility tour and conducted records review and interviews. This agency has investigated the complaint alleging: Resident sustained unexplained injury due to staff neglect/lack of supervision. Based on interviews and records review no indications resident sustained injury due to neglect/and lack of supervision. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies issued during this visit, exit interview conducted, report signed and copy of this report provided for facility records. Unsubstantiatedthe state’s words, verbatim · CDSS document, Feb 11, 2026 · control 24-AS-20251230100053

Allegation investigated: Staff neglect resulted in a resident sustaining multiple pressure injuries

On 01/16/2026, Licensing Program Analyst (LPA) M Vega arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by Administrator - Matthew Mazerik. LPA met with Administrator. During the course of the investigation, LPA conducted a facility tour and conducted resident interviews. Resident interviews revealed that residents are not neglected. Documents reveal that care was and is being provided to residents in care. This agency has investigated the complaint alleging: “Staff neglect resulted in a resident sustaining multiple pressure injuries”. We have found that the complaint was UNFOUNDED, meaning the alleged violation is false, could not have happened and/or is without a reasonable basis. No deficiencies issued. Exit interview conducted. A copy of this report was discussed and provided to Administrator - Matthew Mazerik, whose signature will confirm receipt of this document. Unfoundedthe state’s words, verbatim · CDSS document, Jan 16, 2026 · control 24-AS-20251009152556

Allegation investigated: Resident sustained injuries due to staff neglect. Facility staff failed to seek timely medical attention after the resident fell

On 10/30/2025, Licensing Program Analyst (LPA) V. Gorban arrived unannounced to deliver findings on a complaint investigation. LPA explained the purpose of the visit to staff Anna Martinez and was allowed entry. Administrator was notified of Licensing visit. During the course of the investigation, department conducted a facility tour, conducted interviews, and reviewed records. On 07/30/2025, staff observed R1 trapped between the bed's side rail and the mattress, with his legs and feet touching the floor at 0500 hours. Staff placed R1 on the floor and did not seek medical attention until 0740 hours. R1 was diagnosed with temporary paralysis on the left side of his body, rhabdomyolysis, as well as bruising, skin tears, and swelling. Staff interviewed acknowledged that EMS should have been called immediately. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. See citations on the attached LIC. 9099D. The issuance of additional civil penalties is pending and currently under review. The details of additional civil penalties will be outlined in a future report to the facility, if any. Exit Interview conducted. Appeal Rights provided. Substantiatedthe state’s words, verbatim · CDSS document, Oct 30, 2025 · control 24-AS-20250801152714

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Oct 31, 2025

87411 (a) Personnel Requirements – General - Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not observe das evidenced by: Based on records reviewed and interviews conducted, facility staff left R1 on the ground after finding R1 trapped by his torso between the bed's side rail and the mattress. This resulted in R1 sustaining temporary paralysis on the left side of his body, rhabdomyolysis, as well as bruising, skin tears, and swelling, which poses an immediate health and safety concern to the resident.the state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: The facility administrator will provide details of formal staff termination letter. Also, administrator will provide a written statement letter that staff are able to follow facility protocol and make good decisions regarding resident care by POC due date to LPA by email.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(d)(5) · Plan of correction due date: Oct 31, 2025

87411(d)(5) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: (5) Knowledge necessary in order to recognize early signs of illness and the need for professional help. Based on records reviewed and interviews conducted, facility staff failed to seek medical services after they found R1 trapped from a fall at 0500 hours. Staff placed R1 on the floor and waited until the house manager called EMS at 0740 hours, which poses an immediate health and safety concerns to the resident.the state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: The facility administrator will provide staff on the job training regarding reside care by POC due date to LPA by email.

Type of visit: Required - 1 Year

On 05/09/2025, Licensing Program Analyst (LPA) V Gorban arrived at the facility unannounced to conduct Required Annual Inspection. LPA met with Administrator (AD) Karie Mazerik, certification number 7008733740 and expiration date 11/13/2025. LPA conducted tour inside and out of facility with AD. Residents observed at the facility during lunch time. The facility was observed to be at a comfortable temperature of 74 degrees, clean, in good repair, and no passageway obstructions or fire hazards observed. Fire extinguisher was observed with a service date of 05/01/2025 Dining area and Kitchen were toured. An adequate supply of perishable and non-perishable food was observed to be properly stored in freezer, refrigerator, and pantry. Food is delivered twice a week on Tuesdays and Thursdays. Refrigerator temperature was maintained at 1.0-degree F. and freezer was maintained at -5-degree F. LPA toured resident bedrooms. Residents' rooms were toured and observed with adequately furnished with bed, dresser, and adequate lighting. Hot water temperature tested at 115 degrees F. LPA observed securely fastened grab bar and non-skid mat in shower area. Medications were stored in a locked medication room. Medications records were reviewed. First Aid Kit was stored in medication room and observed with all required items. LPA toured laundry room and observed chemicals were stored and locked for staff use only. Report continues on attache LIC809-C Facility courtyard was toured and observed to be free from debris. There was outdoor seating available for the residents. A count of residents and staff files were reviewed to have updated required information. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 9020 Register of Facility Clients/Residents Please submit the above forms/information to Fresno CCL by: 05/22/2025 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed. No deficiencies issued during this inspection. An exit interview was conducted with the AD. A copy of this report was given to the AD, whose signature on this form confirm receipt of these reports.the state’s words, verbatim · CDSS document, May 9, 2025

Type of visit: Required - 1 Year

On 5/7/2024, Licensing Program Analyst(LPA) D. Ayers arrived unannounced at the facility to conduct a Required Annual Inspection. LPA met with Administrator Matthew Mazerik and announced the purpose of the inspection. There were 5 residents on hospice at the time of the inspection. LPA toured the facility inside and outside. Pathways and exits were clear and free from obstruction. Smoke-detectors and carbon-monoxide detectors were present and operational. Fire extinguishers had been recently serviced. Outdoor areas were free from hazards and provided sufficient seating for residents. Medications were properly secured and appeared to be administered properly. Sharp items and cleaning supplies were secured and not accessible to residents. Facility was clean and LPA observed a sufficient supply of perishable and nonperishable food stuffs which were properly stored. Common areas were clean, adequately furnished, and adequately lit. Resident bedrooms were clean and had required minimum furnishings. Resident bathrooms were clean, odor free, and water temperature was within required temperature range. The facility employs an Activities Coordinator, and LPA observed facility schedule of planned activities and monthly meal menu. LPA reviewed facility plan of operations and emergency disaster plan. LPA reviewed a sample of resident and staff files, which contained all required records. LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, and a copy of current Administrator’s Certificate to update the facility file. No deficiencies were cited during the inspection, exit interview conducted with Licensee, a copy of the report was provided.the state’s words, verbatim · CDSS document, May 7, 2024