Con Carino Braeburn

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an annual required visit and inspection of the facility. LPA met with Caregiver and gained entry. The reason for this visit was explained. Caregiver contacted Administrator via phone and joined the visit. At approximately 10:45a.m., LPA and Administrator conducted a physical plant tour. Required postings were observed in the hallway. The smoke alarms are operational and are in each bedroom, the hallway and kitchen. There are several carbon monoxide detectors that function properly. The fire extinguishers are in the kitchen and the hallways. The charge date is 03/31/2025. During this visit facility temperature was 74 degrees Fahrenheit. The facility is fire cleared for six (6) non-ambulatory residents; one (1) maybe bedridden; approve for two (2) hospice waivers. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrapped, dated, and stored properly as well. Knives were stored in a locked cabinet in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the kitchen. Staff office space is beside the kitchen.Bedrooms: There were six (6) bedrooms designated for residents' use. Bedroom #1, bedroom #2, bedroom #3, bedroom #4, bedroom #5, and bedroom #6 are all private use that has only one resident. Resident’s bedrooms were properly furnished with appropriate dresser, bedding, and linens with sufficient lighting. Bathrooms: There are three and a half (3.5) bathrooms designated for residents' use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 105.9 degrees Fahrenheit for half bathroom located in the hallway beside the kitchen. Bathroom #1 in inside bedroom #6, hot water measured at 115.2 degrees Fahrenheit. Cont. to LIC 809-C Cont. from LIC - 809 Bathroom #2 is beside bedroom #2. Hot water temperature was measured at 110.5 degrees Fahrenheit. Bathroom #3 is located inside bedroom #3, hot water measured at 112.2 degrees Fahrenheit. There was enough clean linen available in the cabinets in the hallway. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits six (6) chairs. LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and/or tripping hazards throughout the facility. Furniture in common areas was observed to be in good repair. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does have a swimming pool, fenced up and locked. Attached garage and is used for PPE and extra food storage. Laundry Service: There are enough linen available to change weekly or more if needed. Cleaning supplies are being stored in a locked cabinet in the laundry area and garage. Medications: There are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the residents’ doctor. First Aid Kit and Book: Several first aid kits have been inspected and have the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze, first aid manual are updated and it's available for staff use but inaccessible for residents. Staff Files: Records were checked for expired or missing certificates and clearances: LPA conducted a file review of four (4) staff for training, criminal record clearances and current Cardiopulmonary Resuscitation (CPR) certificate. The administrator file was reviewed for current first aid and administrator certificate. Staff files were complete at the time of this visit.Resident Files: Records were checked for requirements and legibility: LPA conducted a file review of six (6) resident records to ensure compliance with licensing forms. Resident records were complete at the time of this visit. No immediate health and safety hazard is noted during this visit. An exit interview was conducted. A copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Mar 16, 2026

Type of visit: Case Management - Annual Continuation

At 3:20p.m., Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted unannounced case management Annual Continuation visit to the facility. LPA met with Administrator and explained the reason for the visit. LPA informed Administrator that this visit was conducted to complete Required 1 year inspection initiated on 04/28/2025. During this visit at about 3:45p.m., LPA and Administrator toured the physical plant areas inside and out. At approximately 4:00p.m. LPA reviewed all five (05) residents records and they were complete at the time of this visit. LPA reviewed four (04) staff files and they had criminal record clearance and Cardiopulmonary Resuscitation (CPR) certificate at the time of this visit. All required documents were appropriately signed and dated. LPA also reviewed residents medication. At approximately 4:45p.m, LPA interviewed all five (05) residents in care. No immediate health and safety hazard is noted during this visit. An exit interview was conducted. A copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Jun 18, 2025

Type of visit: Required - 1 Year

At 2:40p.m., Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an annual required visit and inspection of the facility. LPA met with Caregiver gained entry and explained the reason for the visit. At about 2:45p.m., Caregiver contacted Administrator, Linda Morales arrived and indicated that cannot stay for this visit. Administrator granted permission for caregiver to sign this report. At approximately 3:05p.m., LPA and Caregiver conducted a physical plant tour. Required postings were observed in the hallway. The smoke alarms are operational that are located in each bedroom, the hallway and kitchen. There are several carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen and the hallways. The charge date is 03/30/2025. During this visit facility temperature is at 75 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; one (1) maybe bedridden; approve for two (2) hospice waiver. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found at least two (02) days perishable and seven (07) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked cabinet in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the kitchen. Bedrooms: There were six (06) bedrooms designated for residents' use. Bedroom #1(empty), bedroom #2 -#6 are all private use that has only one resident. Resident bedrooms were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Continue to LIC 809-C Bathrooms: There are three and a half (3.5) bathroom designated for residents' use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 115.8 degrees Fahrenheit for half bathroom located in the hallway beside the kitchen. Bathroom #1 in inside bedroom #6, hot water measured at 117.5 degrees Fahrenheit. Bathroom #2 is beside bedroom #2. Hot water temperature was measured at 118.0 degrees Fahrenheit. Bathroom #3 is located at inside bedroom #3, hot water measure at 116.2 degrees Fahrenheit. There was enough clean linen available in the cabinets in the hallway. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits six (6) chairs. LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Furniture in common area was observed to be in good repair. There are no issues with Fire Clearance. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does have a swimming pool, fenced up and locked. Attached garage and is used for PPE and extra food storage. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the laundry area and garage. Due to time constraints, LPA had to terminate the visit and will return on a later date to complete the Required - 1 Year inspection by reviewing medication, staff files, resident record, interview residents and complete the Compliance & Regulatory Enforcement (CARE) tools. No immediate health and safety hazard is noted during this visit. An exit interview was conducted. A copy of this report was provided to the Caregiver.the state’s words, verbatim · CDSS document, Apr 28, 2025

Allegation investigated: Facility staff did not ensure the resident's call buttons were within reach of the resident. Facility staff not available to meet the needs of the resident. Facility staff do not ensure resident's hygeine needs were met. Staff violated residents rights.

At 10:00am, Licensing Program Analysts (LPAs) Perchui Milena Khurshudyan and Angela Panushkina conducted an unannounced initial complaint visit at this facility to investigate the above allegations. Upon arrival, LPAs met with the Staff, who granted access to the facility. Administrator was contacted and LPAs explained the reason for the visit. Due to the Administrator being out of town a Designee/House Manager, Stacy Santana-Lopez, was called in. During course of the investigation, interviews and record review were made. At 10:05am, LPAs requested resident and staff roster. At 10:10am, LPAs requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, relevant to the investigation. At approximately 10:15am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 10:20am – 12:30pm, LPAs interviewed the facility Manager, four (4) staff, three (3) out of six (6) residents, who were able to communicate and one (1) family member. Continue on LIC9099-C Unsubstantiated Allegation: Facility staff did not ensure the resident's call buttons were within reach of the resident. It was alleged that R1 had no call button within the reach and could not attain anyone’s attention for 1.5 hours. To investigate this allegation LPAs conducted an interview with the House Manager and were informed that the facility provides bells to all residents. However, Alzheimer's residents are not being provided with the bell, due to not being able to comprehend and or use it. Interview with four (4) staff members revealed that all residents are being checked every one to two hours. Moreover, the facility has an awake staff at night and all residents are being checked regularly, as scheduled. Lastly, two (2) out of six (6) residents interviewed expressed no concerns regarding this allegation. Therefore, based on the interviews and LPAs observation this allegation is deemed Unsubstantiated at this time. Allegation: Facility staff not available to meet the needs of the resident. It was alleged that R1 could not attain anyone’s attention for 1.5 hours, believed the overnight care staff S1 had fallen asleep. To investigate this allegation LPAs conducted an interview with the House Manager and S1 and concluded that facility has overnight awake staff, also every 1 to 2 hours the staff regularly check on all residents. In addition, LPAs interviewed two (2) out of six (6) residents and they stated staff always responds to their calls during the nighttime. Moreover, interview with a family member also revealed that all facility staff provide a great care and are available to assist residents upon request. Therefore, based on the interviews and LPAs observations this allegation is deemed unsubstantiated at this time. Allegation: Facility staff do not ensure resident's hygiene needs were met. It was alleged that R1 had long, unkempt nails and the staff did not ensure the hygiene needs were met. To investigate this allegation LPAs conducted an interview with the Administrator and a House Manager and were informed that R1 has very high standards and is always out from the facility. Although, the facility has a scheduled Podiatrist come to the facility every two (2) months, R1 stopped receiving his services due to other personal appointments. During the interview with five (5) residents, LPAs observed all residents manicure and pedicure is well taken care of. Lastly, interview with two (2) out of six (6) residents expressed no concerns regarding this allegation. Therefore, based on the interviews and LPAs observations this allegation is deemed unsubstantiated at this time. Continue on LIC9099-C Allegation: Staff violated residents rights. It was alleged, that R1 had a small purple bruise on the back of his/her right hand, about the size of a dime, which was also caused by S1. To investigate this allegation, LPAs reviewed R1s Centrally Stored Medication and Distraction Record (CSMDR) and observed that R1 is currently receiving a blood thinner that can cause bruising. Moreover, LPAs conducted interviews with the Administrator, House Manager and four (4) staff members and all parties interviewed denied ever abusing residents. In addition, two (2) out of six (6) residents interviewed expressed no concerns regarding this allegation and informed LPAs that they are very pleased with the staff's care provided. Lastly, interview with a family member also revealed that no resident was ever witnessed to be abused by the staff. Therefore, based on the interviews and file reviews, LPAs found this allegation is deemed Unsubstantiated at this time. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jun 11, 2024 · control 31-AS-20240606110421

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Perchui Milena Khurshudyan and Angela Panushkina conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20240606110421. LPA met with the House Manager and explained the reason for the visit. During the visit, LPAs observed that the House Manager was listed on LIC500 Personnel Report, however, the House Manager was not associated with the facility through the Licensing Information System (LIS) Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D. Exit interview conducted, appeal rights and copy of report signed and delivered.the state’s words, verbatim · CDSS document, Jun 11, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Jun 13, 2024

Criminal record clearance: (e) All individuals subject to a criminal record review... (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above by hiring one (1) staff member on 03/02/2021 without fingerprint clearance, which poses an immediate health, safety risks to persons in care.the state’s words, verbatim · CDSS document, Jun 11, 2024

Plan of correction: Licensee/Administrator agreed to complete House Manager's fingerprints and associate the staff to the facility. Copy of proof will be submitted to LPA by POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda and Perchui 'Milena' Khurshudyan conducted an annual required visit and inspection of the facility. At 9:37 AM MaruyiI Cantin who is a staff at the facility met with LPAs, explained the reason for the visit. At 10:00AM Linda Morales who is the licensee arrived and was explained the reason for the visit. At 10:56 am, with the assistance of administrator, LPAs took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen and the hallways. The charge date is 3/6/2024. During the visit the facility is at 76 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; one (1) maybe bedridden; approve for two (2) hospice waiver. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPAs found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked cabinet in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the kitchen. Bedrooms: There were six (6) bedrooms designated for residents' use. Bedroom #1, bedroom #2, bedroom #3, bedroom #4, bedroom #5, and bedroom #6 are all private use that has only one resident. Residents bedrooms were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Continue to LIC 809-C Bathrooms: There are three and a half (3.5) bathroom designated for residents' use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 108.8 degrees Fahrenheit for half bathroom located in the hallway beside the kitchen. Bathroom #1 in inside bedroom #6, hot water measured at 110.5 degrees Fahrenheit. Bathroom #2 is beside bedroom #2. Hot water temperature was measured at 118 degrees Fahrenheit. Bathroom #3 is located at inside bedroom #3, hot water measure at 116.8 degrees Fahrenheit. There was enough clean linen available in the cabinets in the hallway. Common Areas: LPAs toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). LPAs observed common areas to be very clean and tidy. LPAs observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Furniture in common area was observed to be in good repair. There are no issues with Fire Clearance. Infection control: Facility mitigation plan to make sure licensee was following current infection control recommendations. LPAs obtain a copy and reviewed the infection control plan during this visit. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does have a swimming pool, this is fenced up and locked. The garage attached and is used for PPE storage and extra food storage. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the laundry area and is located in the garage. Staff Files: LPAs also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Office space is beside the kitchen. Records were checked for expired or missing certificates and clearances: LPAs conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training. Continue to LIC 809-C Medications are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. Resident records were reviewed for requirements and legibility: LPAs reviewed client’s files for physician report. Planned activities are offered. Two (2) out of six (6) residents does not have the recent physicians report and TB test (LIC 602) are not signed by residents primary care physician (PCP). LIC 602 has not been returned by the physician to the resident/ facility, because of this a technical violation is given. Facility is within CA code of Regulations Title 22 or Health and Safety Code. No deficiencies were found, exit interview conducted, copy of report has been issued and discussed.the state’s words, verbatim · CDSS document, Mar 6, 2024