City Home Senior Living

Allegation investigated: Staff do not ensure residents are provided adequate portions of food Staff does not ensure facility has a sufficient supply of perishable and non perishable food Staff does not ensure residents medical equipment is properly maintained Staff dispensed medications not prescribed to residents Staff did not discard discontinued medications Staff did not prevent residents from developing pressure injuries Staff do not seek medical care for changes in residents health conditions

Licensing Program Analysts (LPAs) Edith Conchas and Lavette Farlow conducted an unannounced visit to the facility to commence a complaint investigation and deliver findings on the allegations stated above. LPAs observed the facility conducted interviews with staff, residents and witnesses. Staff do not ensure residents are provided adequate portions of food. Interviews with staff revealed that staff do provide sufficient food for residents and offer seconds to residents. During lunch time, LPAs observed a full meal was provided to residents with a bowl of soup, a sandwich and peas. Based on the interviews this allegation is UNSUBSTANTIATED. Staff does not ensure facility has a sufficient supply of perishable and non-perishable food. During today’s visit, LPAs observations the refrigerator and pantry. Based on LPAs observation there was sufficient supply of food for two days perishable and 7 days nonperishable for the number of residents in care. Continue to LIC 9099-C Unsubstantiated Interviews with staff reveal food is ordered and delivered weekly. Based on the interviews this allegation is UNSUBSTANTIATED. Staff does not ensure residents medical equipment is properly maintained LPAs observed and interviewed staff and witnesses. Observations revealed 1 resident was using medical equipment and was functioning correctly. Interview with witnesses and staff reveal medical equipment for residents R5 and R2 has all the parts of their medical equipment to function correctly. Based on the interviews and observation this allegation is UNSUBSTANTIATED. Staff dispensed medications not prescribed to residents Interviews with staff reveal medication is audited by the administrator to ensure medication is given accurately before staff provide it to residents. LPA observation reveals medication was labeled and separated for each resident name in their own basket. Based on the interviews and observation this allegation is UNSUBSTANTIATED. Staff did not discard discontinued medications Interviews with S5 and S6 revealed that when a medication is discontinued it is relocate to another locked cabinet and notated that it is discontinued upon doctors’ orders and notify the other staff. S5 stated they crush the medications when there is an order that it is discontinued. Based on the interviews and observation this allegation is UNSUBSTANTIATED. Staff did not prevent residents from developing pressure injuries LPAs conducted interviews with staff and relevant parties. Based on interviews and record reviews it was revealed that R2 and R5 have in the past or presently experienced a pressure injury. Interviews and records review revealed they were between stage 1-2. LPAs observed Hospice nurse providing care and treatment and records indicated Home Health and hospice have been providing treatment. Interview revealed that R5 has a red mark that has opened in lower coccyx area and R2 has a pressure injury on R2’s foot. Staff have been monitoring it injury and staff have been treating it by elevating the R2 foot. Based on the interviews and observation this allegation is UNSUBSTANTIATED. Continue to LIC9099-C Staff do not seek medical care for changes in residents’ health conditions. LPAs interviewed staff, witnesses and conducted record reviews. Interviews with staff reveal when there are medical changes to residents in care we report it right away to administrator. Interview with W3 revealed they will notify hospice care staff and facility care staff immediately of any change in condition. Based on the interviews and observation this allegation is UNSUBSTANTIATED. Based on the information above, the allegations are unsubstantiated. A finding of UNSUBSTANTIATED means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report LIC9099 was discussed, and a copy was provided to administrator Lorena Penne.the state’s words, verbatim · CDSS document, May 13, 2026 · control 56-AS-20251119083236

Type of visit: Required - 1 Year

Licensing Program Analyst (LPAs) E. Conchas conducted an unannounced visit for the purpose of an annual inspection. LPA met with Licensee, Ngina Smith. LPA toured the facility inside and out. The facility has no bodies of water. The facility has charged fire extinguishers, operating smoke alarms, and carbon monoxide detectors. Outdoor and indoor passageways were kept free of obstruction. The outside of the facility had a shaded area with seating. Cleaning supplies, medications, and sharps were kept locked and inaccessible to the residents. Cleaning supplies were stored in the laundry area. Medications were kept locked and inaccessible. Sharps were stored in a secured area. LPA toured the kitchen. Food was stored in a safe and healthful manner. LPA observed perishable and non-perishable food. The facility had a sufficient food according to the residents in care. A sample of the facility menu was available for review. LPA toured the resident bedrooms. The resident bedrooms had the required furniture and functional lighting. LPA toured the resident bathrooms. The resident bathrooms were operating in safe and sanitary conditions. LPA observed grab bars and nonskid mats in the shower areas. LPA measured the hot water temperature in the bathrooms. The hot water temperature measured between 105 -120 degrees F. The facility had a supply of additional linen and extra hygiene items for the residents. The facility was also equipped with a complete first aid kit and emergency water supplies. LPA reviewed medications. LPA reviewed staff and resident files. Staff files had the required documentation including a health screening report and current first aid/CPR certification. Resident files had the required documentation including an admission's agreement and updated physician's reports. LPA reviewed medications. Medications appeared to be dispensed appropriately according to the physician's order. No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to the administrator.the state’s words, verbatim · CDSS document, Feb 10, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Edith Conchas made an unannounced case management visit to this facility. LPA met with caregiver Rutrece Dizadore. During today's visit, LPA did a walk-through of the facility. LPA found the following issues: LPA called licensee, left a voicemail but was unable to communicate with them during the visit.LPA attempted to view facility records, staff records and client records. LPA spoke with the caregiver and was informed they do not have access to the office for files. LPA requested to speak to licensee and caregiver stated they have contacted her and is not responding. Two (2) deficiencies were cited. LPA took a tour of the facility and found personal belongings labeled from a another resident in two other residents rooms. One was a perineal care spray and the other item was personal wet wipes. A citation was cited. LPA observed a new resident whom recently moved in on November 15th, 2025. Had a breathing treatment in the closet with out any medication for use of the machine upon emergency. A deficiency was cited. An exit interview was conducted where this report was discussed, and a copy was provided to Caregiver Rutrece Dizadore.the state’s words, verbatim · CDSS document, Nov 21, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(f) · Plan of correction due date: Dec 5, 2025

87412 Personnel Records (f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours... records shall be subject to the following requirements: This regulation was not met as evidenced by: Based on observation, the licensee failed to ensure provide access to staff files to LPA upon request. No staff had key access to obtain and provide files for review.the state’s words, verbatim · CDSS document, Nov 21, 2025

Plan of correction: House manager will request a key from the administrator/licensee for the office. Will maintain access for licensing. And will send an image of the copy of the new key to LPA by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(d) · Plan of correction due date: Dec 5, 2025

87506 Resident Records(d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours... Removal of records shall be subject to the following requirements: This regulation was not met as evidenced by: Based on observation, the licensee failed to ensure provide access to residents file to LPA upon request. No staff had key access to obtain and provide files for review.the state’s words, verbatim · CDSS document, Nov 21, 2025

Plan of correction: House manager will request a key from the administrator/licensee for the office. Will maintain access for licensing. And will send an image of the copy of the new key to LPA by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(3) · Plan of correction due date: Nov 21, 2025

87307Personal Accommodations and Services(3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident...This regulation was not met as evidenced by: Based on observation, the licensee failed to provide individual perosanl care items for each resident. LPA observed personal care items (Perinneal wash) labeled R# in R1 bedroom and perrineal wipes labeled R4 in R2 room.the state’s words, verbatim · CDSS document, Nov 21, 2025

Plan of correction: Caregiver removed items immediately.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(a)(2) · Plan of correction due date: Nov 24, 2025

87465Incidental Medical and Dental Care(a) (2) The licensee shall provide assistance in meeting necessary medical and dental needs... the licensee shall do so directly or make arrangements for this service...This regulation was not met as evidenced by: Based on observation, LPA observed no medication prescribed nor access to medication for breathing treatment for equipment use upon emergency for R2.the state’s words, verbatim · CDSS document, Nov 21, 2025

Plan of correction: Staff will contact hospice agency to request updated medication list including breathing treatment dosage to have in facilty for resident in care.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a comprehensive annual inspection. LPA met with Administrator, Ngina Smith, and discussed the purpose for the visit. The facility is a Residential Care Facility for Elderly (RCFE) with a license capacity of (6), and a current census of (5). LPA conducted a general inspection of facility, which included, but was not limited to, the following: Operation/Physical Plant: Indoor and outdoor passageways were kept free of obstruction. The facility has no swimming pools or similar bodies of water. The facility has sufficient indoor activity space, supplies, and games for residents. Outdoor activity space is enclosed with a latching gate. The facility is maintained at a comfortable temperature of 74 degrees F. Resident bedrooms were furnished with beds, night stands, chairs, bed linen and lighting. Resident bathroom equipment were operating properly and bathrooms were equipped with grab rails and slip mats. The hot water temperatures in the bathrooms measured at 112 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms, fully charged fire extinguisher, laundry equipment, and telephone service. Sharps and cleaning solutions are kept in a locked cabinet. The facility has posted in a common area Community Care Licensing complaint poster, Ombudsman poster, facility license, evacuation plan and emergency telephone numbers. The facility staff schedule reflects 24 hours a day, 7 days a week staff coverage. The facility has a designated area where resident files are stored. Food Service: Kitchen and dining areas were maintained cleaned. Non-perishable and perishable food supply was sufficient for number of residents in care. Cups and plates were sufficient for number of residents in care. The facility’s refrigerator and freezer were operating properly. Health Related Services: The facility maintains record of resident’s medications and medications were centrally stored in a locked cabinet. **continued on next page** Record Review: The facility has a disaster plan and infection control plan for review. The last emergency drill conducted with staff was on 03/27/25. Resident files were reviewed for admissions agreements, physician’s reports, appraisals, emergency contact list, and care plans. Staff files were reviewed for CPR/first aid and job related training, criminal records clearances/exemptions, personnel job history, and health screenings. No deficiencies were issues and advisories were provided during today's visit. An exit interview was conducted were this report was discussed and copy provided to Administrator Smith at the conclusion of the visit.the state’s words, verbatim · CDSS document, Apr 4, 2025

The state marks this report as 9 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Mary Rico conducted an announced visit to complete a pre-licensing inspection and component III. LPA met with Licensee/Administrator Ngina Smith. The pending application is for a change of ownership for a Residential Care Facility for the Elderly (RCFE). The approved fire clearance granted for six (6) non-Ambulatory residents on 10/30/2023. The interior and exterior were toured of the pending facility. Overall, the pending facility is clean and in good condition. LPA observed all bedrooms to be appropriately furnished with adequate lighting. Bathroom toilets, showers have grab bars and non-skid mats. The hot water temperature in the kitchen was measured at 118 degrees Fahrenheit. LPA observed food storage and preparation areas to be clean and sanitary. Refrigerator and freezer temperatures are maintained at appropriate temperatures. All appliances are clean and operating properly. There is a sufficient supply of linens, towels, and personal hygiene items. The first aid kit was reviewed; all items are present including a First Aid Manual. LPA observed an adequate supply of recreation and leisure items and activities. The backyard is completely enclosed with functioning gate to exit to front yard. Outdoor space is suitable for resident use that includes a covered patio with a table and chairs. LPA observed the fire extinguishers to be recently serviced and completely charged. Smoke alarms and carbon monoxide detectors are present and functional. Medications will be centrally stored and secured in a locked cabinet. All hazardous materials such as, cleaning, and disinfecting supplies, knives and other sharps are locked and inaccessible to residents. All required forms are posted in a common area. Pre-Licensing Inspection is complete and has no deficiencies. No corrections need to be made. An exit interview was conducted where this report was discussed and provided to Licensee Ngina Smith.the state’s words, verbatim · CDSS document, Jan 8, 2024