Chateau Pleasant Hill

Type of visit: Case Management - Incident

On 05/26/2026 at 10:15 AM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported missed medication that occurred on 05/13/2026 that was reported on 05/14/2026. LPA met with Executive Assistant, Victoria Young, and explained the purpose of the visit. Jon Mccraw gave verbal authorization on the phone for Young to sign the report. LPA received an incident report that Resident 1 (R1), R2, and R3 did not receive their morning insulin on 05/13/2026. Interview with S1 indicated that the facility nurse was not available during the morning medication pass and all 3 residents' insulin dosage was missed. LPA reviewed and obtained the following documents including but not limited to Incident Report dated 05/14/2026, Progress Notes, Medication Administration Record (MAR), physician's order, M.D Communication/ Advice Form, and physician report (LIC602A). A review of R1, R2, and R3's signed physician's order indicated that R1, R2, and R3 are scheduled to have their first dosage of insulin at 8:00 A.M. Interviews with staff members and M.D Communication/ Advice form indicated that the facility contacted the appropriate parties such as the physician for R1, R2, and R3 on 05/14/2026. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiency by POC date may result in additional Civil Penalties. Exit interview conducted with Young. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, May 26, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jun 5, 2026

87465(a)(4) Incidental Medical and Dental Care (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: The licensee did not comply with the section cited above when R1, R2, and R3 did not receive their morning insulin which posed a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, May 26, 2026

Plan of correction: By POC date, Executive Assistant agrees to have an in-service to ensure that there’s communication between facility staff when there’s coverage needed.

Allegation investigated: Staff did not ensure the facility is pest free

On 11/19/2025 at 4:00 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Executive Director (ED), Jon McCraw to deliver findings of above allegation. LPA explained the purpose of the visit with ED. During the investigation, LPA G. Luk interviewed staff (S) and obtained documents including the resident roster, emergency information, and pest control reports/invoices. LPA L. Alexander interviewed witnesses (W). Allegation: Staff did not ensure the facility is pest free Finding: Unsubstantiated Unsubstantiated LIC9099-C (Page 2) On 07/31/2025, LPA G. Luk interviewed S1, who provided the following information: S1 stated that the facility is in the process of replacing the mulch with the landscaping crew. The facility has a contract with a pest control company (Eco Lab), and Eco Lab sprayed all first-floor apartments approximately 2–3 months prior. S1 reported that the facility takes cleanliness seriously. When reports regarding roaches are submitted, a work order is created in the facility’s internal system; however, these work orders are retained only for a limited period. S1 stated that the pest issue began around May 2025. On 11/03/2025, LPA L. Alexander interviewed W1 and W2 regarding the pest concerns. W1 stated that the facility is taking appropriate action regarding the cockroaches and reported not having seen a roach in approximately one week. W2 stated that they observed cockroaches in one of the apartments around May/June, but have not seen any recently. W2 confirmed that the facility conducted pest treatment in the apartment where cockroaches had been seen. LPA Alexander reviewed Eco Lab invoices for service dates 05/16/25, 05/22/25, 06/23/25, 07/10/25, and 07/28/25, which documented treatment services for interior insects throughout the building, including resident apartments. 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. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 19, 2025 · control 15-AS-20250723104537

Allegation investigated: Staff are not following residents incontinent plan Staff are not following residents special diet Staff did not ensure residents hopital bed was set up for resident

On 11/19/2025 at 3:15 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Executive Director (ED), Jon McCraw to deliver findings of above allegation. LPA explained the purpose of the visit with ED. During the investigation LPAs interviewed Staff (S) and Residents (R). The following documents were obtained: Resident's (R1's) Admissions Agreement, Physician's Report, Face Sheet, Continence Care Resident Roster, Staff Roster, Monthly Task Logs (05/25, 06/25, 07/25), Service Plan Detail (05/08/25), Hospice Care Plan Calendar, Hospice Care Notes (Started 04/27/25), Hospice IDG Comprehensive Assessment and Plan of Care Update Report (05/21/2025), Progress Notes, "notes for family" (07/13/2025), Pleasant Hill Police Incident Report #2507070026 (07/07/2025) and DME order delivery receipt (04/25/25). LIC9099-C Continued... Unsubstantiated LIC9099-C (Page 2) Allegation: Staff are not following resident’s incontinent plan Finding: Unsubstantiated LPA reviewed R1’s Service Plan dated 05/08/25, which indicates that R1 requires Continence Care six (6) times per day, with care partners completing brief checks every two (2) hours to ensure R1 remains clean and dry. Review of chart notes dated 07/13/25 – 07/17/25 indicates that care partners were performing checks every two hours to reposition R1 and ensure they were clean and dry, as documented. In addition, the staffing schedule confirmed caregiver coverage for the required six-times-per-day continence care schedule. Allegation: Staff are not following resident’s special diet Finding: Unsubstantiated LPA reviewed R1’s Physician’s Order dated 07/02/25, which prescribes a pureed diet with thin liquids. Review of chart notes dated 07/13/25 – 07/17/25 reflects that staff offered R1 foods and liquids consistent with the ordered diet, including soup, yogurt, pudding, mashed potatoes, Cream of Wheat, cranberry juice, and water. Documentation indicates that R1 would eat or drink at times and would occasionally refuse food, which is within resident rights. LIC9099-C LIC9099-C (Page 3) Allegation: Staff did not ensure resident’s hospital bed was set up for resident Finding: Unsubstantiated S1 stated that once they knew that the mattress was delivered they put the mattress in place. LPA reviewed records that showed delivery of DME including mattress was completed on 04/25/25. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations is UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 19, 2025 · control 15-AS-20250707103621

Type of visit: Required - 1 Year

On 10/08/2025 at 10:00 AM, Licensing Program Analysts (LPAs) L. Alexander and K. Nguyen arrived unannounced to conduct the Required Annual Inspection. Upon entry, LPAs stated the purpose of the visit to front desk. Administrator Jon McCraw certification 7012974740 expires on 12/04/2026, joined later at around 11:00 AM. LPAs toured the facility with Jon including but not limited to 8 resident’s apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. LPAs observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 74 degrees F. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in a sample of residents’ bathrooms were measured at 109.6, 104.6, 105.1, and 110-degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Sharps are locked and inaccessible to residents in care. Fire Extinguisher dated 07/23/2025. Emergency disaster last update on 9/10/2025. Fire drill was last conducted on 08/27/2025. Liability Insurance effective from 7/1/25 to 7/1/26. Report Continue on LIC 809c... At 11:45 AM, LPAs reviewed 8 residents records. At 2:02 PM, LPAs reviewed 9 staff records and 9 of 9 are associated with the facility. The following deficiencies were observed: - At around 1:00PM LPAs conducted staff files reviews show S1 and S2 do not have health screen and TB on files. - At around 2:20PM LPAs observed R1 room contained unlocked medication (Mucinex) The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted and a copy of this report and appeal right is provided.the state’s words, verbatim · CDSS document, Oct 8, 2025

Type of visit: Case Management - Deficiencies

On 7/31/2025 at 1:45PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a case management visit. LPA met with Executive Director, John McCraw and explained the purpose for the visit. During the complaint investigation (#15-AS-20241025150045) conducted by LPA L. Alexander-Washington, the following deficiency was observed. Eviction letter dated 10/14/2024 issued to R1 did not ensure eviction notice is in compliance with regulation under “Eviction Procedures”. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Jul 31, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(d)(1) · Plan of correction due date: Aug 8, 2025

Eviction Procedures.(d)The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. (1)The notice to quit shall include the following information: This requirement is not met as evidence by: Based on record review, licensee did not comply with the section cited above by not ensuring eviction notice is in compliance with regulation which poses a potential health and safety risk to the persons in care.the state’s words, verbatim · CDSS document, Jul 31, 2025

Plan of correction: Executive Director (ED) has review "Eviction Procedures" regulation and submitted email notice to CCLD on 11/26/2024. Original eviction notice was rescinded and new eviction notice was provided on 12/12/2024. Deficiency cleared.

Type of visit: Case Management - Other

On 07/17/2025 at 12:00pm Licensing Program Analysts (LPAs) L. Alexander and K. Nguyen arrived unannounced to conduct a case management visit to follow-up on a death report received by Community Care Licensing that was faxed on 07/14/2025. LPAs met with Executive Director, Jon McCraw and explained the purpose of the visit. Resident (R), R1, passed away on 07/14//2025 with an unknown cause of death. LPAs interviewed Staff (S), S1, that stated S1 saw R1 earlier in the morning approximately 7:45 am on 07/14/2025 to deliver R1 breakfast. S1 stated that R1 was up and when asked R1 stated R1 felt ok. S1 stated S1 returned back to R1's room just to check in and observed R1 sitting at R1 dining room table and slouched over R1 walker. S1 called the Med Tech to R1's room and Medtech started cardiopulmonary resuscitation (CPR) on R1. LPA's reviewed LIC 624, and Death Report indicated that the cause of death was unknown declared by the paramedics when they arrived. During today's visit LPAs obtained additional information pertaining to R1's death: Physician's Report S2 will obtain death certificate and will send to LPA No deficiencies issued during the visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 17, 2025

Allegation investigated: Facility did not provide a safe environment for residents in care.

On this day, June 19, 2025, Licensing Program Analyst (LPA) Delmundo arrived unannounced to deliver the findings for the above allegation. LPA met with Executive Director Jon McCraw, and informed the reason for visit. During the course of investigation, LPA obtained copies of resident roster, LIC610E Emergency Disaster Plan, Fire Evacuation Plan, Contra Costa Fire Protection District Inspection Notice, contract and invoice for door installation, and communication with contractor pertaining to the door seal installation addendum. LPA also conducted inspection. The following were interviewed: Executive Director (ED), staff (S1) and resident (R1) on 4/21/22; fire inspector (FDI) on 5/20/25. ....continued on 9099C Substantiated R1 stated there were 2 fire issues – the gaps on the doors and trash in the stairwell. The ED stated the facility doors were upgraded and the lock system were checked. The issue about the gaps on the doors were brought to the vendor's (contractor) attention; however, there were circumstances that were beyond the facility’s control and fixing the gaps was not fixed as scheduled. The ED also stated there were trash and recycle bins in the stairwell which the fire marshal asked them to remove. Inspection Notice showed trash can and recycling bin from stairwell 2nd and 3rd floors were removed. FDI stated the trash is a fire hazard because it is combustible and was in a protected space. FDI further stated that the trash was in obstruction in the path of egress and considered an immediate risk.Therefore, the allegation is substantiated. Deficiency is cited from Title 22 California Code of Regulations and listed on 9099D. Deficiency was discussed with ED. Exit interview conducted. Appeals Rights and copy of this report provided.the state’s words, verbatim · CDSS document, Jun 19, 2025 · control 15-AS-20220418123053

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Jun 20, 2025

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. -This requirement is not met as evidenced by: -Based on interviews and record review, the licensee did not comply with the section above in trash and recycle bins in the stairwells which posed an immediate safety risks to the persons in care.the state’s words, verbatim · CDSS document, Jun 19, 2025

Plan of correction: Corrected. The bins had been removed.

Allegation investigated: Staff unlawfully evicted a resident

On 04/10/2025 at 1:50 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Executive Director (ED), Jon McCraw to deliver findings of above allegation. LPA explained the purpose of the visit with ED. During the investigation, the Department obtained the following documents from facility: Resident's (R1's) Admissions Agreement, 30-Day Eviction Notice, Resident Health Identification Information, Physician's Report (11/18/24), Initial Interview (08/30/23), and Individual Service Plan (01/01/25). LIC9099-C Continued Unfounded LIC9099-C (Page 2) Allegation: Staff unlawfully evicted a resident Finding: Unfounded It was alleged staff unlawfully evicted R1. Based on information obtained, R1 was issued a second eviction on 12/14/24. However, LPA reviewed a copy of the eviction notice and confirmed that the letter meets the requirements of the eviction procedure (CCR 87224). Based on interview with staff (S1), Although R1 refuses help with Activities of Daily Living (ADLs), the facility continues to provide care to R1. This agency has investigated the complaint alleging Staff unlawfully evicted a resident. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 10, 2025 · control 15-AS-20250121113617

Type of visit: Case Management - Other

On 04/10/2025 at 2:30 PM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management concurrently with Complaint investigation (15-AS-20250121113617) visit. LPA met with Executive Director, Jon McCraw, and explained the purpose of visit. During a complaint investigation (15-AS-20241025150045), LPA obtained and reviewed the following records for Resident (R1): Preplacement dated 8/30/2023, Appraisal dated 8/30/2023 and Physician's Report dated 08/28/2023 with an diagnosis of Mild Cognitive Impairment (MCI). Additionally, LPA reviewed multiple incident reports where R1 made sexual advances towards two (2) staff (S1 and S2) on 9/28/2023, 12/18/2023, 1/22/2024, 3/12/2024, and 10/11/2024. However, based on record review, LPA did not observe an updated appraisals and medical assessment to address these new behaviors. There is no indication in the preplacement and reappraisal from 8/30/2023 that resident has a history of these behaviors. LPA obtained a copy of an updated medical assessment dated 11/18/2024 where it indicated R1 was diagnosed with dementia. LPA received an Individual Service Plan (appraisal) from ED on 01/02/2025 for R1. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights providedthe state’s words, verbatim · CDSS document, Apr 10, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(e) · Plan of correction due date: Apr 17, 2025

87463 Reappraisals (e) The licensee shall immediately...bring any significant change in condition...to the attention of the appropriate licensed medical professional...other specialized care provider. Documentation of such communication shall be added to the resident's record and shall include:... This requirement is not met as evidence by: Based on interview and record review the licensee did not comply with the section cited above in by performing reappraisals in significant changes of condition which poses a potential health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 10, 2025

Plan of correction: Administrator agreed to conduct an In-Service training with all staff responsible for reappraisals and submit signature sign-in sheet to CCLD by POC due date.

Allegation investigated: Staff are not accepting resident back for re-entry.

On 02/11/2025 at 12:34 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct initial 10-day complaint visit for the above allegation. LPA met with Executive Director (ED), Jon McCraw, and explained the reason for the visit. During the investigation, the Department obtained Resident (R), R1’s physician’s report (01/30/25), exception letter request (01/31/25), and After Visit Summary with discharge notes (dated 01/30/25), Resident Face Sheet and Admissions Agreement. LIC9099-C Continued... Unfounded LIC9099-C (Page 2) Allegation: Staff are not accepting resident back for re-entry. Finding: Unfounded On 02/06/2025 LPA interviewed Witness (W1). W1 stated that R1 was treated for an infection that they got while they were in the hospital and was ready to be discharged back to the facility. W1 stated that they received phone calls from R1’s responsible party and that they were told that Staff (S1) was not accepting R1 back to the facility. W1 stated that R1’s responsible party told them that they did not know if R1 was colonized with an prohibited health condition. On 01/31/2025 S1 submitted a formal exception request (CCR 87616) to accept and retain R1 whom has a prohibited health condition (CCR 87615(a)(4)). The Department granted approval of an exception to accept R1 on 02/06/2025. This agency has investigated the complaint alleging “Staff are not accepting resident back for re-entry.” We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 11, 2025 · control 15-AS-20250205123313

Type of visit: Case Management - Other

On 02/11/2025 at 2:00 PM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit. LPA met with Executive Director, Jon McCraw, and explained the purpose of visit. While LPA L. Alexander was conducting a complaint investigation(15-AS-20250205123313) on 02/11/2025. During record review LPA observed that facility did not notify Community Care Licensing Division (CCLD) of Resident's (R1) hospitalization. LPA interviewed Staff (S1) and S1 stated that S2 completed an incident report but did not have the receipt of date and time incident report was faxed to CCLD. LPA obtained a copy of an Incident Report that was generated by S2. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights providedthe state’s words, verbatim · CDSS document, Feb 11, 2025

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

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: This requirement is not met as evidence by: Based on interview and record review the licensee did not comply with the section cited above in by notifying CCLD of R1's hospitalization (LIC624) which poses a potential health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 11, 2025

Plan of correction: Administrator agreed to read the regulation and conduct an In-Service training with staff on reporting requirements. Submit training sign-in sheet to CCLD by POC due date.

Allegation investigated: Illegal eviction

On 11/26/2024 at 10:25 AM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Executive Director (ED), Jon McCraw to deliver findings of above allegation. LPA explained the purpose of the visit with Executive Director. During the course of the investigation, LPA interviewed witness (W) W1, three (3) staff (S) S1, S2 and S3 and resident (R) R1. LPA obtained and reviewed documents for R1 including Physician’s Report, Residence and Services Agreement, Individual Service Plans dated 08/30/23, 10/04/23, 12/10/23, 06/09/24, 08/01/24 and 09/30/24, staff documented observations, final notice and eviction letters, dated 01/24/24, 03/15/24 and 10/14/24. LIC9099-C Continued Substantiated Allegation: illegal eviction Finding: Substantiated On 10/30/2024, the LPA interviewed Witness (W1). W1 stated that Resident (R1) received a 30-day eviction notice dated 10/14/2024 from ED. Based on interview with W1, they denied having awareness of R1’s sexual behaviors. W1 stated that they had a phone conference with S4 around October 2023 regarding care needs for R1. W1 stated that the next formal care conference was on 06/03/2024 over the phone. W1 stated that they were informed by text message of the January 2024 incident where R1 verbalized sexually inappropriate things to an employee. W1 stated that during a phone call with ED on 10/14/24 that is when they were informed of the March 2024 incident. W1 also stated the ED admitted that they didn’t notify incident and W1 didn’t receive written notices. W1 stated that they never received copies of the letters that was given to R1 regarding warnings for making inappropriate sexual advancements to employees and residents. On 11/01/2024, the LPA interviewed Staff, and Resident. S1 stated that R1 made inappropriate comments to them on two separate occasions. LPA interviewed R1 that admitted making inappropriate remarks to staff. On 11/11/2024, the LPA interviewed S2 that stated R1 made an inappropriate comment which was directed to them through a text message earlier this year on their work phone. LIC9099-C Continued LIC9099-C Continued Based on record review, the eviction letter provided to R1 does not meet the requirements of eviction notices under Health and Safety 1569.683. The failure to notify R1’s responsible party the same day and mail a copy of eviction letter to responsible party. Mail or fax the eviction letter and a written report to the Department within 5 (five) days of notice. Licensee failed to do a new Needs and Services Plan with new behaviors. The eviction letter lacked alternative housing resources, by giving more than 1 option. The licensee is responsible in assisting the resident with relocation and not put the responsibility on the resident for their own placement. Also, there was the incorrect address for Empowering Aging (local ombudsman office). Failure to include information for State Long Term Care Ombudsman for filing a complaint. Based on LPA’s observations and interviews conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 26, 2024 · control 15-AS-20241025150045

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.683 · Plan of correction due date: Nov 27, 2024

§1569.683 Eviction notices; reasons for eviction contents; service (a) In addition to complying with other applicable regulations, a licensee of a residential care facility for the elderly who sends a notice of eviction to a resident shall set forth in the notice to quit the reasons relied upon for the eviction, with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. In addition, the notice to quit shall include all of the following: (1) The effective date of the eviction. (2) Resources available to assist in identifying alternative housing and care options, including public and private referral services and case management organizations. (3) Information about the resident's right to file a complaint with the department regarding the eviction, with the name, address, and telephone number of the nearest office of community care licensing and the State Ombudsman. (4) The following statement: "In order to evict a resident who remains in the facility after the effective date of the eviction, the residential care facility for the elderly must file an unlawful detainer action in superior court and receive a written judgment signed by a judge. If the facility pursues the unlawful detainer action, you must be served with a summons and complaint. You have the right to contest the eviction in writing and through a hearing." (b) The licensee, in addition to either serving a 30-day notice, or seeking approval from the department and serving three days notice, on the resident, shall notify, or mail a copy of the notice to quit to, the resident's responsible person. This requirement is not met as evidenced by: Based on interview and record review the licensee did not comply with the section cited above in serving R1 with an appropriate eviction notice that did not contain all items required under regulation, which poses a potential health and safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 26, 2024

Plan of correction: The Administrator will read the regulation and submit self-certification that it has been read, understood and they will comply going forward to CCLD by POC due date. In addition, the licensee shall rescind the eviction, notify resident, responsible party, and issue legal notice if that is still licensee’s plan.

Type of visit: Required - 1 Year

On 11/01/2024 at 02:00 PM, Licensing Program Analysts (LPAs) D. Doidge and L. Alexander arrived unannounced to conduct the Required Annual Inspection. Upon entry, LPAs stated the purpose of the visit to Ruth Hernandez-Saleh Resident Liaison at 02:10PM. Administrator Jon McCraw certification 6042869740 expires on 12/04/2024, joined later. LPAs toured the facility with including but not limited to 6 residents apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. LPAs observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 76 degrees F. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in a sample of residents’ bathrooms were measured at 110, 107.9, 108.4, 106, and 105 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps are locked and inaccessible to residents in care. Fire Extinguisher dated 07/24/2024. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 11/08/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report Liability Insurance Reviewed: LIC 610E Emergency Disaster Plan Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 1, 2024

Type of visit: Required - 1 Year

On 10/27/2023 at 12:20 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Executive Director, Jon McCraw and explained the purpose of the visit. The facility’s fire clearance was approved for 2770 Pleasant Hill Rd. 50 Clients May Be All Non-Ambulatory First Floor Only. 2726 Pleasant Hill Rd, 76 Clients May Be All Non-Ambulatory First and Second Floor. Hospice Waiver for Six (6) Residents. LPA toured the facility with Jon including but not limited to 4 residents apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 72 degrees F. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in a sample of residents’ shared bathroom were measured at 105, 106, 108 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. At 2:50 PM, LPA reviewed 7 residents records. At 4:30 PM, LPA reviewed 10 staff records and 10 of 10 have current first aid training and associated to the facility. LIC 809C...Continued LIC809 Continued.... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 11/03/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 27, 2023

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.