Comfort Living Elder Care 3

Allegation investigated: Staff do not meet resident's incontinence care needs. Staff yell at resident. Staff do not safeguard resident's confidential information.

On 2/3/2026 at 2:20 PM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility staff Lily Crawford and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 5. Allegation: Staff do not meet resident's incontinence care needs It was alleged that staff do not meet resident’s incontinent care needs. This investigation consisted of interviews with facility staff and residents, and records review. On 01/07/2026 LPA Hughes conducted a visit to the facility and spoke with 2 out of 3 facility staff. Interview with the facility administrator stated that facility staff should be checking on residents in 15-minute intervals, stating that (2) residents in the facility require assistance with grooming and dressing. Interview with facility staff (S2) stated that they primarily assist resident (R1) with changing undergarments. Continuation 9099-C Unsubstantiated Interview with resident (R1) stated that facility staff do meet their incontinent care needs. Additional interviews with 2 out of 3 residents did not express any concerns about facility staff not meeting their grooming and care needs, as they do not require assistance from staff. LPA attempted interview with resident (R4) but was unable as they have limited verbal capacity. LPA reviewed facility care charting records for resident (R1), for the months of November 2025, December 2025, and January 2026 and observed daily incontinent care changing for resident (R1) however the record did not specify times. There is not enough evidence to corroborate this allegation, therefore the allegation is unsubstantiated. Allegation: Staff yell at resident It was alleged that staff yell at a resident in care. This investigation consisted of interviews with facility staff, and residents in care. On 01/07/2026 LPA Hughes conducted a visit to the facility. LPA spoke with 2 out of 3 facility staff who denied allegations of ever yelling at residents in care. LPA spoke with 2 out of 3 residents who stated they have no concerns about facility staff yelling at them or have ever observed staff yelling at other residents. Interview with resident (R1) reflected that staff do not yell at them. LPA attempted to interview 2 additional residents in care but was unable as both residents have limited English speaking capabilities. There is not enough information present to corroborate this allegation, therefore the allegation is unsubstantiated. Allegation: Staff do not safeguard resident's confidential information It was alleged that staff do not safeguard resident’s confidential information. This investigation consisted of interviews with facility staff and residents in care. On 01/07/2026 LPA Hughes conducted a visit to the facility. LPA spoke with 2 out of 3 facility staff who denied allegations of disclosing resident’s confidential information. LPA spoke with 2 out of 3 residents in care who stated that staff have never disclosed their confidential information or information of other residents to them. Interview with resident (R1) stated that they have overheard facility staff sharing their confidential information with others in the facility. LPA attempted to interview (2) additional residents in the facility but was unable as the residents English speaking capabilities were limited. There was not enough information or evidence present to corroborate this allegation; therefore, the allegation is unsubstantiated. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.the state’s words, verbatim · CDSS document, Feb 3, 2026 · control 27-AS-20260102141541

Type of visit: Required - 1 Year

On 01/07/2026 at 12:30am, Licensing Program Analyst (LPA) Shakaricka Hughes arrived at the facility to conduct an unannounced annual inspection. LPA Hughes met with caregiver Lily Crawford and explained the purpose of the visit. Lily called the facility designated administrator Mariam to inform that CCLD was present in the facility. The current census is 5 with 2 facility staff. This facility is a single story building licensed to serve (6) non-ambulatory residents. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility to be free of odor, clean and in good repair. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 120.2 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the kitchen area and was last serviced on 11/18/2025. LPA observed the facility has a public telephone in the common area and the facility has the required posters posted. Facility thermostat was observed at 75 degrees Fahrenheit. LPA observed toxins located in the kept locked in the kitchen cabinet inaccessible to residents. LPA observed sharp knives kept locked in the kitchen and inaccessible to residents. Continuation 809-C LPA checked medication storage and found medication to be locked away and inaccessible to residents. LPA reviewed 3 out of 5 residents medications and the medication administration record (MAR) was complete. The first aid kit was checked and contained the required components. LPA requested resident and staff files for review. LPA reviewed 5 out of 5 resident files and they were complete. LPA reviewed 2 staff files, and it was complete. LPA reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared. The following documents will be email to LPA by 01/08/2026 (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (3) LIC 610 Current Emergency Disaster Plan (4) Proof of Current Liability Insurance (5) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulations, and a copy of these LIC 809 report were provided to the facility.the state’s words, verbatim · CDSS document, Jan 7, 2026

Type of visit: Required - 1 Year

On 1/7/25 at 1:30pm Licensing Program Analyst (LPA) Kevin Gould arrived at Comfort Living Elderly Care 3 for the purpose of conducting a required 1 year annual inspection. LPA met with staff, Alegrine Nacar and together conducted a tour of the home. LPA and staff evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor and clean. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA observed a hole in the closet door in bedroom #1 and the closet door in room #3 is off the rails and not operating as designed. LPA measured the water temperature, temperature measured at 105 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications. LPA observed insulin stored in the fridge without a lock box and accessible to residents in care. LPA also observed the facility is not disposing of syringes correctly and LPA did not observe syringe disposal in accordance with title 22 regulations. LPA also observed the facility is still pre pouring medications; the medications guide discontinued this practice in 2021. LPA Requested the following documents for facility file: LIC 308 Designation of Facility Responsibility, LIC 500 personnel report, LIC 9020 client roster and current administrator certificate. Per California Code of Regulations, Title 22 the follow deficiencies are cited during today's inspection. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jan 7, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct an annual inspection visit. Upon arrival, LPA met with caregiver Elegrin Nacar and explained the reason for the visit. Elegrin contacted Administrator Mariam Soumahora who advised that Elegrin assists LPA with today’s visit. Administrator holds current certification #6049437740 and expires on 8/22/2024. The facility is licensed to serve up to (6) six non-ambulatory residents. Hospice approved for 3. There are currently 6 residents in care. LPA toured the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms; resident bathrooms, laundry area, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed required furniture and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The hot water temperature was measured at 110.7*F which was within the required range of 105-120*F. The temperature inside the facility was measured at 72*F which was within the required range of 68-85*F. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. Continued on 809-C LPA requested resident and staff files for review. LPA reviewed (6) resident files and (3) staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. The following forms and documents were requested to be submitted within 15 days: LIC 308 Designation of Administrative Responsibility, LIC 500 Personnel Report, Copy of Administrator Certificate, LIC 610 Emergency Disaster Plan and Proof of Current Liability Insurance. Per California Code of Regulations, Title 22, no deficiencies were cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Dec 6, 2023

Allegation investigated: Staff do not keep the facility free from pests Staff are not providing adequate care and supervision to the residents

On 10/06/2023 at 8:00 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with direct care staff, Abietuwaja Edokpolo and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 5. A brief interview was conducted with care staff. LPA Lee also read the report findings to administrator, Mariam Soumahora, via telephone because administrator was not present during today’s visit. At 8:30 AM, LPA Lee toured the facility with care staff. LPA Lee also reviewed staff criminal record clearances and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. Allegation: Staff do not keep the facility free from pests. It was alleged that the staff did not keep the facility free from pests. This investigation consisted of records reviewed, interviews with staff and residents. It was learned that 4 out of 5 residents had not witnessed any pest in the facility and has no concerns. Continued LIC 9099-C Unsubstantiated The investigation also revealed that 3 out of 3 facility staff denies seeing any pest in the facility. It was learned that the facility is receiving pest control services from “California Pest Control.” The facility received services on 08/14/2023 from 4:55 to 5:45 PM, 08/29/2023 from 4:48-5:38 PM and 09/19/2023 from 3:21-3:34 PM. Per LPA Lee visit and tour of the facility on 09/26/2023 and today’s visit, LPA Lee did not observe any pest in the facility. Based on information provided through interviews and records reviewed, the allegation is deemed UNSUBSTANTIATED although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation staff do not keep the facility free from pests. Allegation: Staff are not providing adequate care and supervision to the residents. It was alleged that the staff are not providing adequate care and supervision for the residents. This investigation consisted of records reviewed, interviews with staff and residents. It was learned that 4 out of 5 residents has not witnessed any facility staff not providing adequate care and supervision to the resident. It was also learned that 4 out of 5 residents have no concerns regarding care and supervision. The investigation also revealed that 3 out of 3 facility staff denies not providing adequate care and supervision to the residents. Based on information provided through interviews and records reviewed, the allegation is deemed UNSUBSTANTIATED although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation staff are not providing adequate care and supervision to the residents.the state’s words, verbatim · CDSS document, Oct 6, 2023 · control 27-AS-20230919110101