Climb Sierra Madre RCFE

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced required- 1 year visit. LPA met with Patricia Wong, Wellness Coordinator and explained the purpose of the visit. Shortly after, administrator, Hector Vargas arrived and and assisted LPA. The facility is approved to serve residents age range 60 and over, approved for capacity of (40) residents of which (30) ambulatory and (10) non ambulatory; approved hospice waiver for (5) hospice residents. The facility provides care and support services primarily tailored for blind and visually impaired adults. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are trained on the emergency infection control plan and following hand hygiene techniques. Emergency Infection Control Plan was reviewed and updated on 01/26/2026. Operational Requirements: Facility does not accept nor retain residents with dementia. Plan of Operation was reviewed and the Infection Control Plan has been added to the Plan. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 07/15/2027. Fire drill was last conducted on 07/15/2026. Physical Plant/Environment Safety: The facility is a single story building located in a commercial area. The facility consists of (2) separate buildings: 1st building (single story) consists of (20) resident rooms and (14) bathrooms, (5) community shower room, laundry room, outside patio, medication room, living room/receiving area, dining area, kitchen and pantry. 2nd building in the back (2 story): 1st floor consists of administrative office, conference room, storage room, detached garage. 2nd floor consists of accounting office and medical office. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. The facility is equipped with cameras in the common areas. The bathrooms were observed to be clean and operational. Cleaning supplies and toxic substances are inaccessible to residents. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit, bathroom #1 (107.1 deg F) and bathroom #2 (112.8 deg F). The kitchen was observed to have sufficient amount of perishable and non-perishable food supplies. LPA observed perishable food was stored in covered containers at the appropriate temperatures. There are cameras without audio in the common areas. Fire extinguishers were observed throughout the facility and were last serviced on 04/21/2026. Smoke detectors, fire sprinklers and pull fire alarm system observed and hard wired to the City of Sierra Madre Fire Department. *****CONTINUED ON LIC809-C***** Staffing: There are sufficient staff to provide care and supervision to the residents, including the Administrator. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. Administrator's certificate is valid, expires on 06/23/2028. Personnel Records-Training: LPA reviewed (5) staff files. Proof of staff training, Health clearance, Fingerprint/Clearance exemptions, Criminal Record statement, Vaccinations and 1st Aid/CPR training are current. Resident Rights-Information: Resident personal rights, complaint hot line information and visitors policy posters are posted. Facility provides internet services to all residents and have access to the facility's special phone and tablet. Planned Activities: There is sufficient space to accommodate both indoor and outdoor activities. LPA observed sufficient equipment and supplies to accommodate residents with special needs to meet the requirements of the activity program. Monthly activity calendar is posted. The facility has a Resident Council and council members/residents meet on a monthly basis. Last meeting was held on 07/23/2026. Food Service: Sufficient food supply is stored in the kitchen and pantry area consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies are stored in a separate building. Pesticides and cleaning supplies are kept away from the food preparation areas. Staff wear hairnets and disposable gloves while preparing food. Kitchen has a dietary board indicating residents' modified and/or restricted diet list. Incident Medical and Dental: Facility has (3) medical carts where residents' medications are stored in their original containers (mostly bubble packed). Medications were reviewed to ensure they are given as prescribed and documented properly. Medications are administered as prescribed by the Physician. The facility uses the Medication Administration Record (MAR) log to document medications given. Resident Records/Incident Reports: (5) resident files were reviewed. They contained Admission Agreements, Physician's Reports, Pre Placement Appraisal, TB clearance, IPPs, Functional Capability Assessment, Physician's Orders, Medical Consent, Medication Records. Disaster Preparedness: Emergency and Disaster Plan is in place, containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. Residents with Special Health Needs: There are (0) hospice residents. There are (2) residents with restricted health condition and currently receiving home health services. There are no residents with prohibited health conditions. No deficiency cited. Exit interview and a copy of this report was provided to the Administrator, Hector Vargas.the state’s words, verbatim · CDSS document, Jul 27, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA was met by Hector Vargas, Administrator and explained the purpose of the visit. Facility is licensed for 40 residents age range 60 and over, of which 30 ambulatory and 10 non-ambulatory; approved hospice waiver for (5) hospice residents. There are currently (34) residents, 60 years and older residing in the facility, (0) bedridden and (0) hospice residents. Residents residing in the facility receive case management services provided by San Gabriel Pomona Regional Center. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has a updated Infection Control Plan in place. Staff are trained on the emergency infection control plan and following hand hygiene techniques. Emergency and disaster plan was completed and up to date. Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. Facility does not accept or retain residents with dementia. LPA reviewed the Liability Insurance that is in place. LPA reviewed the Surety bond that is in place. Fire and Earthquake drill was last conducted on 07/09/2025. Physical Plant/Environment Safety: The facility is a single-story building located in a commercial area. The facility consists of (2) separate buildings: the 1st building (single story) consists of (20) resident rooms and (14) bathrooms, (5) community shower rooms. Outside patio, Medication room, Laundry room, Living room, Dining area, Kitchen and Pantry. Physical Plant/Environment Safety [Cont.]: The 2nd building (2 story) consists of Administrative office, Medical Office, Storage room, Detached garage, Conference room and Accounting Office (upstairs). The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. LPA inspected five (5) residents' rooms and each resident bedroom has the required furniture such as the bed, bed frames, nightstand, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen, and the linen is in good condition. The bathrooms were observed to be clean and operational. Each resident rooms had a bathroom that included a water basin and toilet. Cleaning supplies and toxic substances are inaccessible to residents. The LPA along with the Administrator toured and tested hot water temperature in five (5) random resident rooms (Rooms #5, # 9, 11, 12, 19 and shared shower room). Water temperature readings measured between 105.0 degrees F and 111.3 degrees F within the required 105 - 120 degrees Fahrenheit. LPA measured the Shared Shower room hot water temperature at 110.3 degrees F which is within the required 105 – 120 degrees F. Sharps are kept locked and inaccessible from residents. Cleaning supplies are kept locked and inaccessible from residents. There are cameras without audio in the common areas. Carbon Monoxide detectors were tested and working properly. Fire extinguishers were observed throughout the facility and were last serviced on 04/15/2025. Smoke detectors, fire sprinklers and pull fire alarm system observed and hard wired to the City of Sierra Madre Fire Department. Staffing: There are sufficient staff to provide care and supervision to the residents, including the Administrator. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and are associated to the facility. Personnel Records-Training: LPA reviewed five (5) staff files includes: Personnel Record, Health clearance, TB Result, Criminal Background Clearance, Employee Rights, 1st Aid/CPR training are current. Administrator's certificate expires on 06/23/2026. Resident Rights-Information: Resident personal rights, complaint hotline information and visitors’ policy posters are posted. Per Administrator, facility provides internet services to all residents and have access to the facility phone. Planned Activities: There is sufficient space to accommodate both indoor and outdoor activities. Outdoor has a shaded area for activity purposes. LPA observed sufficient equipment and supplies to accommodate residents with special needs to meet the requirements of the activity program. Monthly activity calendar is posted. The facility has a Resident Council and council members/residents meet on a monthly basis. Food Service: Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. There are five (5) residents that have a modified diet. Sufficient food supply is stored in the kitchen and pantry area consisting of 2-day perishables, 7-day non-perishables, and emergency food supplies. Pesticides and cleaning supplies are kept away from the food preparation areas. Incident Medical and Dental: Medications were reviewed for (5) residents to confirm medication is given as prescribed and is documented properly. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are centrally stored and in their original containers. Medications are administered as prescribed by the Physician. Medications are bubbled packed. The first aid kit was observed and has all required items. Resident Records/Incident Reports: LPA reviewed five (5) resident files that include: the Face Sheet, Admission Agreements, Physician's Reports, Ambulatory Status, TB Clearance, Individual Program Plan (IPP), and Personal Rights. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place with contact numbers and at least 2 relocation sites. Residents with Special Health Needs: Three (3) residents are receiving home health services. There are three (2) residents with a Restricted Health Condition and the LPA reviewed the current Restricted Care Plans in file. There are no residents with prohibited health conditions. Per the California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during today’s visit. Exit interview was held and a copy of the report was provided to Hector Vargas, Administrator.the state’s words, verbatim · CDSS document, Aug 28, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA was met by Hector Vargas, Administrator and explained the purpose of the visit. Facility is licensed for 40 residents age range 60 and over, of which 30 ambulatory and 10 non-ambulatory; approved hospice waiver for (5) hospice residents.There are currently (34) residents, 60 years and older residing in the facility, (0) bedridden and (0) hospice residents. Residents residing in the facility receive case management services provided by San Gabriel Pomona Regional Center. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. Staff are trained on the emergency infection control plan and following hand hygiene techniques. Emergency and disaster plan was completed and up to date. Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. Facility does not accept nor retain residents with dementia. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expired 07/15/2024. Administrator stated that it has been renewed and will send a copy of the current/valid liability insurance to LPA. Surety bond in the amount of $30,000.00 is in place. Fire drill was last conducted on 06/19/2024. Physical Plant/Environment Safety: The facility is a single story building located in a commercial area. The facility consists of (2) separate buildings: 1st building (single story) consists of (20) resident rooms and (14) bathrooms, (5) community shower rooms. Outside patio, Medication room, Laundry room, Living room, Dining area, Kitchen and Pantry. 2nd building (2 story) consists of Administrative office, Medical Office, Storage room, Detached garage, Conference room and Accounting Office (upstairs). The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. The facility is equipped with cameras in the common areas. The bathrooms were observed to be clean and operational. Cleaning supplies and toxic substances are inaccessible to residents. At 2:30pm, LPA along with the Administrator toured and tested hot water temperature in five (5) random resident rooms (Rooms #2, #5, #8, #19 and pubic restroom). Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The kitchen was observed to have sufficient amount of perishable and non-perishable food supplies. LPA observed perishable food was stored in covered containers at the appropriate temperatures. There are cameras without audio in the common areas. Fire extinguishers were observed throughout the facility and were last serviced on 04/24/2024. Smoke detectors, fire sprinklers and pull fire alarm system observed and hard wired to the City of Sierra Madre Fire Department. *****CONTINUED ON LIC809-C***** Staffing: A total of (41) staff members provide care and supervision to the residents, including the Administrator. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. Administrator's certificate expired on 06/03/2024 but provided proof that renewal was submitted to CCL. Personnel Records-Training: LPA reviewed (4) staff files. Proof of staff training, Health clearance, Fingerprint/Clearance exemptions, Criminal Record statement, Vaccinations and 1st Aid/CPR training are current. Resident Rights-Information: Resident personal rights, complaint hotline information and visitors policy posters are posted. Per Administrator, facility provides internet services to all residents and have access to the facility phone. Planned Activities: There is sufficient space to accommodate both indoor and outdoor activities. LPA observed sufficient equipment and supplies to accommodate residents with special needs to meet the requirements of the activity program. Monthly activity calendar is posted. The facility has a Resident Council and council members/residents meet on a monthly basis. Food Service: Sufficient food supply is stored in the kitchen and pantry area consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Staff wear hairnets and disposable gloves while preparing food. Incident Medical and Dental: Medications were reviewed for (5) residents to confirm medication is given as prescribed and is documented properly. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are centrally stored and in their original containers. Medications are administered as prescribed by the Physician. Medications are bubbled packed. First Aid kit was observed. Resident Records/Incident Reports: A total of four (4) resident files were reviewed. They contained Admission Agreements, Physician's Reports, Pre Placement Appraisal, IPP, TB clearance, Functional Capability Assessment, Physician's Orders, Medical Consent, Medication Records, and P & I Money Records. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place. Residents with Special Health Needs: Three (3) residents are receiving home health services. There are no residents with prohibited health conditions. No deficiencies cited. Exit interview conducted and a copy of the report was provided to Hector Vargas, Administrator.the state’s words, verbatim · CDSS document, Jul 19, 2024

Allegation investigated: Staff inappropriately touching a resident in care. Staff not accorded residents dignity in their relationship.

Licensing Program Analyst (LPA) Ashley Calderon conducted a subsequent complaint investigation for the allegations listed above. LPA met with Administrator Hector Vargas and dicussed purpose of today's visit. Initial visit on 7/25/23 consisted of LPA Calderon conducted a health and safety check and obtained a copy of the following for Client #1 (C1) - Client #4(C4): • Client Information/ Face Sheets • Admission Agreements • Agreements and Consent for Medical Treatment • Personal Rights • Individual Program Plan (IPP) • Physician's Reports • Resident Roster and Staff Roster. C1's • Special Incident Reports •Hospital Discharge Report. LPA Calderon alongside with Vargas toured the facility, random rooms, Room # 4,5,10,16 and 20 and common areas included dining room and living room. Medication room was locked. The kitchen was observed and LPA obsevred sufficient perishable and non-perishable food itmes for residents in care. (CONTINUATION 90999-C) Unsubstantiated On today's visit 1/18/24, LPA Calderon collected staff training for Catheter Care, Physician Orders for C1 catheter placement and Physician notes regarding C1 receiving incontinent care. LPA interviewed C1-C4 , LPA interviewed Officer Manager and Licensing Vocational Nurse from Adept Home Health Care Services, whom provide services to C1. LPA interviewed Administrator, Staff #1 and Staff #2 (S1 and S2), telephone interview attempts with Staff #3 and Staff # 4. (S3 and S4). LPA interviewed (2) Service Coordinator via telephonically from San Gabriel Pomona Regional Center, whom worked and have worked with C1 and residents at the above facility. Based on allegation: Staff inappropriately touching a resident in care. Investigation revealed based on interviews with staff, Administrator, S1 and S2 denied the above allegation and stated residents are not touched inappropriately and are not aware of an incident were resident was touched inappropriately. Administrator, S1 and S2 informed LPA residents are treated with respect. S1 and S2 both stated C1 was assisted with activities of daily living (ADL's) and it was reported that C1 was having issues with catheter. S2 informed LPA S1 was not alone during observations when assisting C1 with ADL's, S2 informed LPA they were present with S1 and C1 was not touched inappropriately when caring for ADL's. S1 informed LPA during interview, C1 was not touched inappropriately when assisting C1 with ADL's and informed LPA to have other staff present and staff were ensuring C1 was being observed to provide C1 with appropriate care based on ADL's. LPA interview with C1 revealed C1 answers were inconsistent and interview cannot corroborate with the above allegation. Interviews with clients C2, C3 and C4 informed LPA that they deny the above allegation and staff do not touch them inappropriately or know of any clients whom were touched inappropriately. Interviews reveled that 4 out of 4 clients interviewed had no concerns with staff / S1 coming into their rooms. Interview with Adept Home Health Care Licensing Vocational Nurse whom treats C1 informed LPA not aware of incident were C1 was touched by staff inappropriately. During interviews with C1's former service coordinator and current service coordinator from San Gabriel Pomona Regional Center, both service coordinators informed LPA there has been no concerns regarding C1 and clients at the above facility being touched inappropriately by staff. Based on record review on Catheter Care training, staff are trained on concerns to inform home health nurse and facility administrator regarding catheter clients. Special Incident Report dated 7/24/23 was reported to Licensing and Regional Center regarding C1 received care by licensed professionals due to catheter issues, facility notified home health care and appropriate parties. (CONTINUATION 9099-C) Based on allegation: Staff not accorded residents dignity in their relationship. Based on interviews conducted with Administrator, S1 and S2, staff denied the above allegation and informed LPA residents are respected and treated with dignity. Interviews with clients 4 out of 4 clients informed LPA facility staff treat them with dignity. C1-C4 were unaware of any clients whom were not treated according to their dignity. C1 stated S1 treats them with dignity and is nice towards them. Former Service Coordinator and current service coordinator from San Gabriel Pomona Regional Center informed LPA there were no reports regarding residents not being treated with dignity and denied the above allegation, interview with Adept Home Health Care Services informed LPA, C1 has not reported staff not treating resident(s) with dignity. Based on the LPA's observation, interviews conducted with client and staff and document reviewed, 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 allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided to Administrator Hector Vargasthe state’s words, verbatim · CDSS document, Jan 18, 2024 · control 28-AS-20230724154603