Copper River Retirement Group/Shea

Type of visit: Required - 1 Year

On 12/08/2025, Licensing Program Analyst (LPA) M Vega arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by Staff 1 (S1). Administrator (AD) Stephanie Costa was notified of Licensing visit over the phone and was able to attend the visit. The facility was observed to be at a comfortable temperature, of 74 degrees F. Facility is free of debris, in good repair, and no passageway obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout. LPA observed most residents in common area after lunch. Department phone number and infection prevention information signs were posted in facility. LPA toured facility with Administrator outside. LPA observed pool in the back yard, fenced and the pool gate was locked. Outdoor seating area was observed in good repair and available to residents. Fire extinguisher was observed with a service date of 07/16/2025. All 6 residents’ bedrooms were observed to be with comfortable temperature. Kitchen water temperature was tested and recorded reading of 116.7 degrees F. Medications observed to be locked in closet near front entry to facility. LPA reviewed medication records maintained and accurate as of inspection. Cleaning supplies were observed to be in a locked and inaccessible to residents cabinet in garage. Kitchen LPA observed the required 7 day supply of non-perishable food and 2 day supply of fresh perishables to be properly stored. An emergency disaster supply was observed. Continuation on LIC 809C Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): LIC 308 Designation of Facility Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly LIC 9020 Register of Facility Clients/Residents Copy of current Liability Insurance Copy of current Administrator Certificate Alternate contact information including name, telephone number, & email address. Please submit the above forms/information to Fresno CCL by: 12/22/2025 No deficiencies were observed and cited. Exit interview conducted. Report was signed and copy of this report was provided for facility records.the state’s words, verbatim · CDSS document, Dec 8, 2025

Allegation investigated: Staff do not provide activities for residents in care. Facility food is of poor quality. Facility has inadequate food service for the residents in care.

On 01/09/2025 at 12:30 PM, Licensing Program Analyst (LPA) met with Administrator Shay Ayers to deliver the findings for the above allegations. The department received a complaint on 12/13/2024 alleging that, Staff do not provide activities for residents in care, Facility food is of poor quality and Facility has inadequate food service for the residents in care. During the investigation, LPA interviewed Resident 1 (R1) Residents did not mention any of the prior mentioned complaints.Spoke with R2 and was not able to corroborate allegations. During the course of this investigation facility files were reviewed. It was determined that facility does provide activities to residents, food quality is not poor and there is recorded adequate food supply at the facility. Continuation on LIC 9099C Unfounded This agency has investigated the complaint alleging: Staff do not provide activities for residents in care. Facility food is of poor quality, Facility has inadequate food service for the residents in care and We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis therefore we have dismissed the complaint. There were no citations issued during this visit and exit interview was conducted. A copy of this report was provided to Administrator for facility records.the state’s words, verbatim · CDSS document, Jan 9, 2025 · control 24-AS-20241213083056

Allegation investigated: Facility does not have suffiicient staffing to provide care and supervision to the residents in care

On 11/26/2024, Licensing Program Analyst (LPA) M Vega arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Shay Ayers. Based on interviews conducted with staff and residents, and record review, the allegations: Facility does not have sufficient staffing to provide care and supervision to the residents in care is UNSUBSTANTIATED. 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. No deficiencies issued during this inspection. An exit interview was conducted with Administrator. A copy of this report was discussed and provided to Administrator, Shay Ayers, whose signature on this form confirms receipt of this document. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 26, 2024 · control 24-AS-20241119144808

Type of visit: Required - 1 Year

On 11/26/2024, Licensing Program Analyst (LPA) M Vega arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by Staff 1 (S1). Administrator (AD) Shay Ayers was notified of Licensing visit over the phone and was able to attend the visit. AD certification number 6033549740. LPA toured facility with AD Shay Ayers The facility was observed to be at a comfortable temperature, of 71 degrees F. Facility is free of debris, in good repair, and no passageway obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout. LPA observed most residents in common area after lunch playing bingo, others in their rooms resting. Department phone number and infection prevention information signs were posted in facility. LPA toured facility with Administrator outside. LPA observed pool in the back yard, fenced and the pool gate was locked. Outdoor seating area was observed in good repair and available to residents. Fire extinguisher was observed with a service date of 07/22/2024. All 6 residents’ bedrooms were observed to be with comfortable temperature. Kitchen water temperature was tested and recorded reading of 117.6 degrees F. Medications observed to be locked in closet near front entry to facility. LPA reviewed medication records maintained and accurate as of inspection. Cleaning supplies were observed to be in a locked and inaccessible to residents cabinet in garage. Kitchen LPA observed the required 7 day supply of non-perishable food and 2 day supply of fresh perishables to be properly stored. An emergency disaster supply was observed. Continued on LIC 809C LPA reviewed Staff and Resident files. Resident files observed to have updated information. No deficiencies were observed and cited. Exit interview conducted. Report was signed and copy of this report was provided for facility records.the state’s words, verbatim · CDSS document, Nov 26, 2024

Type of visit: Required - 1 Year

On 11/01/2023, Licensing Program Analyst (LPA) V. Gorban arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility. LPA toured facility with staff Thelma. Administrator (AD) Shay Ayers was notified of Licensing visit over the phone and was able to attend the visit. AD certification number 6033549740. Facility has one entrance/exit point. LPA toured facility with Administrator inside and out. Facility pool serviced weekly. LPA observed pool in the back yard, fenced and the pool gate locked for residents safety. The facility was observed to be at a comfortable temperature, of 77 degrees F. Facility is free of debris, in good repair, and no passageway obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout. LPA observed some residents in common area after breakfast watching television, others in their rooms resting. Department phone number and infection prevention information signs were posted thought the facility. Inspecting kitchen LPA observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. An emergency disaster supply was observed. Fire extinguisher was observed with a service date of 07/28/2023. All 6 residents’ bedrooms were observed to be with comfortable temperature. Bathroom water temperature was tested and recorded reading of 105 degrees F. Medications observed to be locked in a cabinet in the kitchen. LPA reviewed medication records appears to be administered properly. Cleaning supplies were observed to be in a locked cabinet in the laundry room. An outdoor seating area was observed operational for residents in care. LPA reviewed Staff and Resident files. Resident files observed to have updated information. No deficiencies were observed and cited. Exit interview conducted. Report was signed and copy of this report was provided for facility records.the state’s words, verbatim · CDSS document, Nov 1, 2023