Cogir of Rohnert Park

Allegation investigated: Medications are not provided to the residents as prescribed Due to lack of staffing, residents needs are not getting met timely Staff do not have required training

Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 2/23/2026 at approximately 9:30am, and met with Interim Administrator, Omar Mendoza,and Tamra Richmond, Business Office Manager. Reporting party (RP) alleges "medications are not provided to the residents as prescribed", "due to lack of staffing, residents needs are not getting met timely", and "staff do not have required training". RP did not provide specific resident names with allegations. LPA reviewed staff files, resident files, facility files, including staff schedule, and conducted interviews with staff and other related parties. Per review of records, and interviews, the investigation revealed that the Interim Administrator is available on-site Monday and Tuesday 9am to 5pm, and Tuesday and Thursday 9am to 11am. Health & Wellness Director, and Nurses from other Cogir communities have come in as needed, to help support the facility. The licensee has hired a new Administrator who will be coming into the facility the first week of March 2026. The Health & Wellness Director was hired and started today, 2/23/26. LPA observed working on shift caregivers and a medication technician. No information obtained to support a violation had occurred. Continued on LIC9099C.. Unsubstantiated The LPA reviewed nine (9) staff files, consisting of resident care associates, and medication- technicians, who are also care associates as needed. All staff had required first aid certification, and CPR certification. Staff had required training. All staff had criminal record clearance as required. LPA reviewed three (3) resident files, including care plans, incidents, and medication records. LPA reviewed three resident files, including care plans, incidents, medical records, and medication/MAR records. Medications are being provided to residents as prescribed. Staff have medication training as required. Staff have caregiver training as required. Per review of records, and interviews conducted, there was no information obtained to support alleged violations had occurred. Based on LPAs observations, record reviews, interviews with staff, and information obtained from other related party(s) there is insufficient information to prove or disprove the allegations of "medications are not provided to the residents as prescribed", "due to lack of staffing, residents needs are not getting met timely", and "staff do not have required training". Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. No deficiencies cited. Exit interview conducted with Omar Mendoza.the state’s words, verbatim · CDSS document, Feb 23, 2026 · control 21-AS-20251209091547

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Alviso conducted a case management inspection, on 2/23/2026 at approximately 2:00pm, and met with Interim Administrator, Omar Mendoza, and Tamra Richmond, Business Office Manager. This case management is being conducted to address a resident incident (R1) that was reported by the facility as required. LPA conducted interviews with staff; and obtained additional information on the incident. A dependent resident (R1) was left sitting on the toilet for a period of approximately fifty-five (55) minutes by a caregiver; The resident requested the staff to return within thirty (30) minutes, but the staff went off shift, leaving the facility. The staff never returned to assist the resident. Resident was left waiting in the bathroom, until a visitor arrived and found them. The visitor notified staff on duty. Administrator stated they suspended the staff, who was involved in the incident, pending an in-house investigation. Investigation was completed by staff, and staff S3 was terminated. LPA was provided a copy of staff's termination. LPA was provided copies of training that was provided to direct care staff on residents' "personal rights", and "providing care needs to residents'". There is sufficient information obtained to support a violation occurred regarding resident's personal rights. Continued on LIC9099C... The following deficiency will be cited, 87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities- In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs, see LIC9099D. Deficiencies will be cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights provided. Exit interview conducted with the Administrator, Omar Mendoza.the state’s words, verbatim · CDSS document, Feb 23, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Feb 27, 2026

87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities- In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. A dependent resident (R1) was left sitting on the toilet for a period of approximately fifty-five (55) minutes by a caregiver; The resident requested the staff to return within thirty (30) minutes, but the staff went off shift, leaving the facility.The staff never returned to assist the resident. Resident was left waiting in the bathroom, until a visitor arrived and found them. The visitor notified staff on duty. This a risk to resident's personal rights.the state’s words, verbatim · CDSS document, Feb 23, 2026

Plan of correction: CORRECTED-ADMINISTRATOR PROVIDED COPIES OF IN-SERVICE HELD WITH ALL DIRECT CARE STAFF. LPA WAS PROVIDED A COPY OF S'3s TERMINATION PAPERWORK. POC CLEARED.

Type of visit: Required - 1 Year

Licensing Program Analyst(LPA) Alviso conducted a required- 1 year inspection, on 2/3/26 at approximately 3:00pm, and met with Rafael Mendoza, Administrator, and Tamra Richmond, Business Office Manager. The facility has a required infection control plan. Hospice waiver is approved for ten (10) residents only. The facility has a required emergency and disaster plan. Facility is fire cleared for seventy-five (75) non-ambulatory residents.Fire cleared resident rooms/units are 157-187 on the first floor, and 257-287 on the second floor. Fire extinguishers were serviced and tagged. The LPA toured the facility with the Administrator, and the Business Office Manager. The facility had sufficient lighting in units/offices observed by the LPA. Sufficient lighting in common areas, restrooms, hallways, and dining room, The kitchen was found to be orderly and clean during the inspection; The freezer and refrigerator were clean and observed to be within required temperatures. Sufficient food supply was observed. All exits were free and clear of obstruction. Medication room was relocated to the 2nd floor; The medication room was locked as required, making medications/over the counter medications inaccessible to residents in care. Housekeeping carts, cleaners/disinfectants were locked, and inaccessible to residents in care. Hot water was measured at 115.7 degrees Fahrenheit. Facility had sufficient furnishings for resident use. Large common area with a library for use by residents. LPA observed the residents in the dining room for the dinner meal being served, and for meal pick-up orders. The LPA will complete the annual inspection at a later date. No deficiencies cited today.the state’s words, verbatim · CDSS document, Feb 3, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA), Alviso, conducted a case management inspection and met with Interim Administrator Omar Mendoza. Interim Administrator is coming in to help ensure administrator coverage, and facility's plan of operation. Interim Administrator is Case management is being conducted to obtain more information on a resident incident report. R1 had a fall and hit their head; Facility staff didn't contact 911 for R1, to ensure a medical professional assesses the resident's head injury. LPA provided the Department's PIN 25-06 by email to the facility administration staff. The resident is on hospice care, but for emergencies not directly related to the expected course of the resident's terminal illness, the facility staff shall immediately telephone emergency response (9-1-1). Per review of information provided by the Administrator, it is the facility's policy and procedure that staff would contact 911 regarding the above incident of R1. Interim Administrator provided proof of training all staff, including facility management/administration staff, in the facility on "managing medical emergencies." There is sufficient information obtained to support that a violation occurred. Facility staff failed to contact 911 for R1, after resident fell and hit their head. This deficiency will be cited, 87465(g) Incidental Medical and Dental Care-The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights provided. Exit interview conducted with the Interim Administrator, Omar Mendoza.the state’s words, verbatim · CDSS document, Nov 20, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(G) · Plan of correction due date: Dec 1, 2025

87465(g) Incidental Medical and Dental Care-The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met as evidenced by: LPA's review of incident report, interviews with staff, and review of facility's policy. Staff failed to contact 911 for resident incident, resident hit their head. This is a health & safety risk to residents in care, as well as a personal rights risk.the state’s words, verbatim · CDSS document, Nov 20, 2025

Plan of correction: CORRECTED BY INTERIM ADMINISTRATOR OMAR MENDOZA,WHO PROVIDED PROOF OF TRAINING, AS REQUIRED FOR CORRECTION OF THE DEFICIENCY, DURING TODAY'S INSPECTION. POC CLEARED.

Allegation investigated: Staff did not provide toileting needs to resident Staff did not address residents' change in condition Staff did not seek needed medical attention for residents'

Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 8/25/25 at approximately 9:45am, and met with the Administrator, Kelly Ording, LPA met with new Health & Wellness Director Reporting party alleges "staff did not provide toileting needs to resident, staff did not address residents' change in condition, staff did not seek needed medical attention for residents". LPA reviewed residents', R1 and R2, records, including care plan, progress notes, medication records, and medical documentation. LPA conducted interviews with staff, S1, S2, and S3, and other related parties, regarding allegations. LPA obtained copies of records. Investigation revealed R1 is able to communicate needs to staff, per medical assessment. Per file review of records, and interviews, resident R1's care needs for incontinence are being met by care staff and med-technicians. Continued on LIC9099C... Unsubstantiated Per review of records, interviews conducted, progress notes and medical documentation reviewed, caregivers and medication- technician staff, addressed resident incidents of R1 as needed, assisting with toileting/incontinent needs, providing needed care, per care plan, and contacting 911 when needed, per review of records. Resident R1 went out 911 on 7/24/25 due to weakness, and pain; and R1 returned to the facility on 7/28/25. Facility staff called 911 for R1 on 7/31/25 due to continued decline with pain and weakness, per file reviews and interviews. R1 returned on 8/22/25 on hospice care services. Investigation revealed R2 is able to communicate needs to staff, per medical assessment. Per file review of records and interviews, resident R2 has prescribed pain medications for chronic pain/health diagnosis; The pain medications are to be provided to the resident as ordered, some pain medications are daily dosed/regularly provided specific times, and others are provided as needed. Per review of medication records, and resident progress notes, R2's pain medications are provided to R2 as prescribed. R2 receives incontinent care per review of records. R2 went out 911 on 8/22/25 due to complaints of pain, and difficulty breathing. Staff caregiver/medication- technician observed the need for the resident to be assessed by a medical professional, 911 was called and emergency response transferred resident to the ER. Per interviews, R2 receives assistance with medications when requested by the resident, and as ordered by the Physician. Per interviews, R2 receives needed care and assistance, per care plan, needs, and observations. The investigation revealed that there was differing information obtained from information provided to the Department regarding the allegations. There was no information obtained that supported the violations had occurred. Based on LPAs observations, record reviews, interviews with staff, and information obtained from other related party(s) there is insufficient information to prove or disprove the allegation of "staff did not provide toileting needs to resident, staff did not address residents' change in condition, and staff did not seek needed medical attention for residents". Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. No deficiencies cited. Exit interview conducted with Kelly Ording, Administrator.the state’s words, verbatim · CDSS document, Aug 25, 2025 · control 21-AS-20250820140658

Allegation investigated: Staff are over-medicating the resident Staff leaves the resident soiled

Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 8/14/2025 at approximately 10am, and met with the Administrator Kelly Ording. Reporting party alleges "staff are over-medicating the resident, and staff leaves the resident soiled". LPA reviewed facility records, including medication records, and MARs records. LPA reviewed resident's, R1, records, including care plan, hospice plan, and medication records/medication orders. LPA obtained copies as requested. Per staff file reviews, staff have required training, and fingerprint clearance as required. Investigation revealed that per LPA's review of medication records, MARs records, and interviews, the resident, R1, was provided their medication as prescribed. In review of hospice file there was no record of medications issues, of medications not being provided to R1 as ordered. Continued on LIC9099C... Unsubstantiated Per review of hospice records, there was no information documented of hospice staff having concerns with resident care or incontinent care of R1, by facility staff. The investigation revealed that there was differing information obtained from information provided to the Department regarding allegations. There was no information obtained that supported the violations had occurred. Based on LPAs observations, record reviews, interviews with staff, and information obtained from other related party(s) there is insufficient information to prove or disprove the allegation of "staff are over-medicating the resident, and staff leaves the resident soiled". 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 cited. Exit interview conducted with Kelly Ording, Administrator.the state’s words, verbatim · CDSS document, Aug 14, 2025 · control 21-AS-20250721151111

Allegation investigated: Staff forced a resident to sit in the facility dining room. Medications are not provided to the resident as prescribed

Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 8/14/2025 at approximately 10am, and met with the Administrator Kelly Ording. Reporting party alleges "staff forced a resident to sit in the facility dining room and medications are not provided to the resident as prescribed". LPA reviewed facility records, staff file, and resident, R1 & R2, files. LPA conducted interviews with staff and other related parties. Staff, S2, has required hiring documents, required fingerprint clearance, and required training, for caregiver/medication-technician, per file reviews. LPA obtained copies of requested records. Investigation revealed that per LPA's review of medication records, MARs records, and interviews, the residents, R1 and R2 are receiving their medications as prescribed. The investigation revealed that per conducted interviews, and review of records, there was no information obtained that resident is forced to sit in the dining room. Continued on LIC9099C.. Unsubstantiated Per review of facility records, early am medications are provided approximately at 6:00am, morning medications are provided from 7am -9am, noon medications from 11am to 1pm, evening medications from 4pm to 6pm, and bedtime medications starting at 8pm. Medications/Critical medications would be provided within 30 minutes before scheduled time ordered or 30 minutes after scheduled time ordered. The investigation revealed that there was differing information obtained from information provided to the Department regarding allegations. There was no information obtained that supported the violations had occurred. Based on LPAs observations, record reviews, interviews with staff, and information obtained from other related party(s) there is insufficient information to prove or disprove the allegation of "staff forced a resident to sit in the facility dining room, and medications are not provided to the resident as prescribed". 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 cited. Exit interview conducted with Kelly Ording, Administrator.the state’s words, verbatim · CDSS document, Aug 14, 2025 · control 21-AS-20250723170611

Allegation investigated: Unqualified adult providing residents' medications

Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 7/29/25 at approximately 9:45am, and met with the Administrator, Kelly Ording, and Tamra Richmond, Business Office Manager. Reporting party alleges "unqualified adult providing residents' medications". LPA requested specific records regarding staff (S3); LPA requested a copy of the facility's policy regarding agency staff and/or private companions in the building. LPA requested documentation of staff S3's qualifications to work in the facility, staff/agency file documents, including medication training. Per interview with Administrator, staff S3 worked two shifts for the facility assisting residents with medications in July 2025; Administrator stated S3 worked previously at the facility, but now has their own staffing agency. LPA discussed the facility's responsibility in providing all care, assisted daily living needs (ADL's), to the residents' in the facility. Ensuring resident's current care needs are provided/met by the facility staff. Per interview with S3, they used to work at the facility assisting residents' with medications but left to start an agency for care staff. LPA requested a business card, but S3/ staff stated they didn't have one to provide the LPA. Continued on LIC9099C... Substantiated Continued from LIC9099, dated 7/29/2025.. Per interview with S3, they used to work at the facility assisting residents' with medications but left to start an agency for care staff. LPA requested a business card, but S3/ staff stated they didn't have one to provide the LPA. LPA requested Administrator to provide documents on file regarding S3 as a staff of the facility and/or documents as an agency registry staff in the facility providing services. Administrator stated they didn't have any agency staff documents on S3, but have repeatedly requested required documentation from S3, and S3 has never provided it to the facility. Administrator stated they would see what documents they have on former staff S3, and will request S3 to complete required documentation to them. Administrator stated they would provide records on S3's qualifications, and their agency/registry documentation to the LPA. Records were provided to the LPA. Per review of records, staff interviews, and obtained information, the investigation revealed, S3 last completed required medication training hours on 11/11/2023 and 11/12/2023. This is out of compliance with health & safety code requirements, there is initial medication training hours required, including medication shadowing hours, and medication training annually. This deficiency will be cited, HSC1569.69(a)(1)(b) Employees assisting residents with self-administration of medication; training requirements, see LIC9099D. Per review of Guardian, criminal record clearance database, S3 is not associated to the facility and was separated by Cogir of Rohnert Park on 12/5/2023. It was also identified that S3's fingerprint clearance was separated from North Bay Home Care agency on 10/9/2024, and separated from North Bay Home Care, INC. agency on 2/18/2025. This is out of compliance with title 22 regulation requirements, 87355(e)(2)(3) Criminal Record Clearance, it will be cited, see LIC9099D. There was sufficient information obtained to support that a violation occurred regarding the allegation. The preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited. Failure to correct deficiencies by due dates, may result in additional deficiency citations and/or civil penalties being assessed. Exit interview conducted with the Administrator Kelly Ording. Appeal Rights Provided.the state’s words, verbatim · CDSS document, Jul 29, 2025 · control 21-AS-20250707151553

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.69 · Plan of correction due date: Jul 30, 2025

HSC1569.69(a)(1)(b) Employees assisting residents with self-administration of medication; training requirements-Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: In facilities licensed to provide care for 16 or more persons, the employee shall complete 24 hours of initial training, including 16 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 8 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first four weeks of employment. Each employee required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training in each succeeding 12-month period This requirement was not met as evidenced by:Per review of records, the investigation revealed, S3 last completed required medication training hours on 11/11/2023 and 11/12/2023. This is a health & safety risk to residents' in care.the state’s words, verbatim · CDSS document, Jul 29, 2025

Plan of correction: Licensee to ensure all facility staff have required medication training per HSC1569.69, including any appropriately cleared agency staff that are assisitng residents' with medications. Licensee to submit written plan of future facility compliance regarding HSC requirement by all staff assisitng residents' with medications. POC due 7/30/2025. Note: In addition to the above, If facility hires S3 to work in the facility, and they handle medications, submit completed HSC medication proof of training, and update employee roster, LIC500, to the Department.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2)(3) · Plan of correction due date: Jul 30, 2025

87355(e)(2)(3) Criminal Record Clearance- All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department or Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement was not met as evidenced by: Per review of Guardian, criminal record clearance database, S3 is not associated to the facility and was separated by Cogir of Rohnert Park on 12/5/2023. It was also identified that S3's fingerprint clearance was separated from North Bay Home Care agency on 10/9/2024, and separated from North Bay Home Care, INC. agency on 2/18/2025. This is a risk to the' health & safety of all residents'.the state’s words, verbatim · CDSS document, Jul 29, 2025

Plan of correction: Licensee to ensure compliance with requirements of regulation 87355 regarding criminal record clearances, with facility staff and/or employees of licensed home health agencies. Ensure staff have required criminal record clearance and are associated to the facility as needed per regulation. Licensee to submit written plan of future facility compliance regarding 87355 regulation requirements. POC due 7/30/2025

Type of visit: Required - 1 Year

Licensing Program Analyst(LPA) Alviso conducted an annual inspection, on 2/13/25 at approximately 1:40pm, and met with Tamra Richmond, Business Office Manager. Jose Acumabig, Administrator was not on-site today and available to meet with the LPA. The facility has a required infection control plan. Hospice waiver is approved for ten (10) residents only. The facility has a required emergency and disaster plan. Facility is fire cleared for seventy-five (75) non-ambulatory residents. Fire cleared resident rooms/units are 157-187 on the first floor, and 257-287 on the second floor. LPA reviewed six (6) resident files. All files were complete. LPA reviewed six (6) staff files, including training. Per record reviews, last fire drill was 1/29/25 and last elopement drill was on 9/25/24. LPA met with the Activity Director Shaianne Chantavong, and reviewed the facility's activity calendars; Per review of records, activities are being conducted with assisted living residents as required. LPA observed that all stairwells of the facility had evacuation chairs, to be used as needed for residents in an emergency. There was a sufficient supply of food, perishable and non-perishable. The medications were locked up and stored appropriately as required. Medication narcotics were double locked and counted on each shift. PRN and medication records were found to be accurate, and maintained as required. There was a sufficient supply of personal protective equipment (PPE) to use as needed. Sufficient supply of disinfectants/cleaners, and paper products. All cleaners/disinfectants were locked up and inaccessible as required. Sufficient furnishings for residents use. All hallways throughout the facility had sufficient lighting for residents in care. Fire extinguishers were serviced and tagged as required. All exits were free and clear of obstruction. The facility was at a comfortable temperature for residents in care. LPA observed residents engaged in a facility activity during the inspection. Continued on LIC809C.. LPA is requesting the following documents be updated and submitted by 3/13/25: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan -Update if changes, submit copy and/or copy of last page of annual review completed Infection Control Plan- Update if changes, submit copy and/or copy of last page of annual review completed Copy of LIC400 Handling of Client Cash Resources, include copy of surety bond if handling cash. Copy of Current Liability Insurance The following deficiency was observed during the inspection: LPA checked a resident bathroom sink, and the hot water was checked at 122.9 degrees Fahrenheit, which is not within regulation. Deficiency cited,87303 (e) (2) Maintenance & Operation- Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C), see LIC809D. Deficiency will be cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Tamra Richmond, Business Office Manager. Evaluation report LIC809/809D and Appeal rights were provided to Tamra Richmond, BOM, for Administrator Jose Acumabig.the state’s words, verbatim · CDSS document, Feb 13, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst(LPA) Alviso conducted a continued annual inspection, on 2/13/24 at approximately 1:30pm, and met with Tamra Richmond-Business Office Manager. Administrator was not available to meet with the LPA. The annual visit was started on 1/24/24, see LIC809 of that date. The facility has a required infection control plan. Hospice waiver is approved for ten (10) residents only. The facility has a required emergency and disaster plan. Facility is fire cleared for seventy-five (75) non-ambulatory residents- effective 1/19/24; Fire cleared resident rooms/units are 157-187 on the first floor, and 257-287 on the second floor. Last fire drills were held on 1/31/24 and 1/17/24, per review of the facility's emergency drills binder. An elopement drill was held on 1/24/24, per review of the facility's elopement drills binder. LPA observed that all stairwells of the facility had evacuation chairs, to be used as needed for residents in an emergency. There was a sufficient supply of food, perishable and non-perishable. All resident bathrooms have grab bars, and non-slip flooring and/or mats for use as needed. The medications were locked up and stored appropriately as required. There was a sufficient supply of personal protective equipment (PPE) to use as needed. LPA reviewed resident files. All files were complete. LPA reviewed staff files. All staff have required criminal record clearance. Six (6) out of eight (8) direct care staff didn't have first aid, per file reviews. This deficiency will be cited, Personnel Requirements - General Section 87411(c)(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross, see LIC809D. Deficiencies will be cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights provided. Exit interview conducted with the Administrator.the state’s words, verbatim · CDSS document, Feb 13, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst(LPA) Alviso conducted Required -1 Year inspection, on 1/24/24 at approximately 2:45pm, and met with Administrator Jose Acumabig. Currently there are twenty-one (21) residents in care. The facility has a required infection control plan. LPA toured the assisted living area, first (1st) and second (2nd) floors. All resident units have been renovated, but two. These two units are now vacant, and will be renovated before being occupied. All bathrooms observed by the LPA, had grab bars as required/needed for resident use. All fire extinguishers were serviced and tagged. Facility has applied for an increase in capacity; Facility requested to go from forty-five residents, to a total of seventy-five residents. Facility fire clearance is approved for seventy-five (75) non-ambulatory residents- effective 1/19/24; Fire cleared resident rooms/units are 157-187 on the first floor, and 257-287 on the second floor. The facility will now be licensed for seventy-five (75) non-ambulatory residents; The increase in capacity is approved, effective 1/24/24. LPA is requesting the following documents be updated and submitted by 2/24/24 LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan -Update if changes, submit copy and/or a letter/ last page of annual review completed Infection Control Plan- Update if changes, submit copy and/or a letter/ last page of annual review completed Copy of LIC400 Handling of Client Cash Resources, include copy of surety bond if handling cash. Copy of Current Liability Insurance Copy of current Administrator Certificate The annual inspection will be completed by the Department at a later date. No deficiencies cited today. Exit interview conducted with Administrator Jose Acumabig.the state’s words, verbatim · CDSS document, Jan 24, 2024