Country Commons

Type of visit: Required - 1 Year

On October 30, 2025, Licensing Program Analyst (LPA) Kayla Adkison, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Michael Foz, Administrator, and explained the purpose of the visit. 15 residents and 2 (two) care staff were present in the facility during the inspection. Additional staff were on-site participating in a scheduled all-staff meeting. LPA and Administrator toured the facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, three (3) resident bedrooms, kitchen, backyard, sun room and (2) two common restrooms. All areas observed were found to be clean and in good repair. LPA observed each bedroom to have the required furnishings, working lights, and windows with screens. Facility has a 2-day perishable and a 7-day non-perishable amount of food. LPA observed a binder containing each residents special dietary concerns. LPA observed all sharps to be kept locked in a kitchen drawer and inaccessible to residents. LPA observed medications to be locked in a med cart and inaccessible to residents in care. Overstock medications are in the process of being moved to the administrator's locked office. The facility is in the process of implementing a new system for tracking medications for clients. LPA observed all toxins and cleaning supplies to be locked in cabinets and inaccessible to clients. LPA observed a calendar of events for residents to view. The facility regularly does partner activities with it's sister facility next door (Country House - 45920038). LPA observed fire extinguishers which were last inspected in August 2025. LPA observed a disaster drill log with the last drill recorded in September 2025. The facility is conducting drills monthly. LPA observed a complete first aid kit ready for emergency use. LPA observed smoke detectors and carbon monoxide in working condition. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA reviewed a total of four (4) residents' files and four (4) staff files which contained all required documentation. All staff are fingerprint cleared and associated to the facility. No deficiencies are being cited as result of this inspection. Exit interview conducted. A copy of this report and Appeal Rights were provided, via email, to Administrator, Michael Foz, via email.the state’s words, verbatim · CDSS document, Oct 30, 2025

Allegation investigated: Facility mismanaged resident's medications.

On 8-27-25 Sarah Benson, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 06-02-25. LPA Benson met with Administrator Michael Foz and Resident Care Cordinator Dakota Newman and explained the purpose of the visit. During the interview process two staff persons were interviewed. The following documents were received and reviewed: staff list with telephone numbers, staff schedules for May and June 2025, MAR, medical records, care notes and incident reports. Continued on LIC9099C, LIC9099D. Substantiated The document review revealed that staff had faxed medications request to R1’s doctor on 5-13-25, 5-15-25 and 5-20-25. The Administrator reported on May 22 I went to the VA in Chico and picked up two missing medications. Review of the Medication Administration Record revealed the two medications were documented and administered to the resident at this time. Further document review revealed the resident went without several other medications for seven days and two medications were never recorded as received or given. Durning interviews staff reported a visit from the VA nurse on 5-21-25. After a review of the residents’ medications, the nurse reported that a medication was not listed by the doctor’s admission, standing orders. Documentation of doctors’ orders dated 5-9-25 did not have the missing resident medication listed as a standing order. On 5-21-25 the nurse stated the missing medication would be delivered by mail. Staff reported on 5-25-25 the nurse phoned to see if the resident had received his missing medication per the visit and conversation on 5-21-25. Staff had stated no they had not received the package. The nurse reported to staff I have record that the medication had been delivered on 5-23-25. Staff reported reviewing security film footage and discovered a package was delivered from UPS on 5-23-25. Staff reported the package was found in the medication room in a drawer on 5-25-25 after security film review. Staff stated when the package was delivered it had the residents name on it so the staff declined to open the package. Staff reported that the facility doesn't usually get medication from UPS and the staff that took the package didn't realize the package was medication. Document review revealed this medication was delivered 5-23-25 and discovered on 5-25-25. Record review of the Medication Administration Record revealed the medication was not recorded or administered to the resident. Based on investigation observations, record review(s) and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D. Appeal rights were explained and provided to the facility representative listed above and exit interview conducted. If any of the cited deficiencies are not corrected by the noted due date, civil penalties may be assessed.the state’s words, verbatim · CDSS document, Aug 27, 2025 · control 59-AS-20250602144454

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Sep 3, 2025

87465 Incidental Medical and Dental Care. (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance...: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on interviews and records reviewed, the licensee/administrator did not ensure that a resident received his medication, when the medication was prescribed. This poses an immediate Health and Safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 27, 2025

Plan of correction: Administrator will spot check residents medications weekly. Administrator will have professional medication training for all staff. Administrator will notify LPA when completed. Administrator will send a copy of staff training with staff signatures.

Type of visit: Required - 1 Year

On 09/10/2024, Licensing Program Analyst (LPA) Jaynae Boyles, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Facility Assistant Administrator, Michael Foz and explained the purpose of the visit. LPA Boyles and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, backyard, shed, and common restrooms. LPA observed the resident bedrooms to have all the required furnishings, working lights/fans with windows with screens. All resident bathrooms observed to be in working order and have the required supplies. LPA observed the resident showers to have bathroom the necessary grab bars, non-skid flooring or shower chair, paper towels, trash can with lids and 20-second hand-washing poster. Hot water was measured throughout the facility and it was within the regulation. Facility has a 2-day perishable and a 7-day non-perishable amount of food. LPA observed medications sharps to be locked inaccessible to residents. LPA observed posted weekly menu and activities for the residents. LPA observed a plethora of supplies for the residents to use. LPA observed fire extinguishers, fire detectors, and carbon monoxide detectors. LPA observed a complete first aid kit ready for emergency use. LPA observed a completed emergency disaster plan, and the required emergency disaster drills conducted within the last 12 months. LPA observed the facility to be clean, in good repair and odor-free. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA reviewed a total of five (5) residents' files and five (5 ) staff files which contained all the required documentation. No deficiency cited as a result of todays visit. Exit interviewed conducted.the state’s words, verbatim · CDSS document, Sep 10, 2024

Type of visit: Prelicensing

On 10/31/2023 Licensing Program Analyst (LPA) Jaynae Boyles arrived at the facility announced to conduct a Pre licensing Inspection. LPA's met with Residential Care Director Nina Eads and explained the purpose of the visit. LPA Boyles and Residential Care Director toured facility together to ensure that the facility is in compliance for seniors with dementia. Areas toured include but are not limited to: common areas, bedrooms, backyard, and restrooms. LPA observed the facility to be clean, in good repair and odor-free. The facility was equip with required fire extinguishers, fire detectors and carbon monoxide detectors. The facility was stocked with the required two day perishable and 7 day non-perishable amount of food for residents and staff. Component III waived. The following items will need to be addressed prior to the facility getting licensed. These corrections are also documented on the current license- 04500540 : -Disaster Drills to be conducted every three months for a total of 4 in 12 months. -Medical orders for residents with 1/2 rails (as postural supports) Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 31, 2023