Country Palms Care Home

Type of visit: Case Management - Incident

LPA Johnson arrived and met with the Staff Reyes, who assisted LPA with the visit. LPA reviewed the discharge summary of R1. The purpose of this visit was to follow up on an incident report sent to Community Care Licensing (CCL) for a visit to Stanford Hospital. LPA reviewed records and medications charting for R1. LPA reviewed the medications log, interviewed Staff and discovered that the resident in question had a history of seizures. The facility reported this information to R1's primary care physician and the department. R1 was sent out to the hospital on 12/02/2025. R1 returned to the facility. R1 has scheduled follow-ups to check labs for new medications and over-all wellness. As a result of this visit no deficiencies were observed. Exit interview conductedthe state’s words, verbatim · CDSS document, Jan 2, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 112.9 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers and carbon monoxide detectors are operational. LPA observed centrally stored medications are kept locked. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 4 resident and 2 staff files, including criminal record clearances. All staff are fingerprinted and cleared. First aid kit was checked and is complete. No deficiencies were cited pursuant to Title 22 rules and regulations, Health and Safety Codes. Exit interview conductedthe state’s words, verbatim · CDSS document, Sep 29, 2025

Type of visit: Case Management - Other

LPA Johnson arrived at the care facility to conduct a case management visit regarding annual fees. LPA toured the facility and spoke with residents. No concerns at this time. According to Licensing Information System, the facility due on 11/17/2025 for annual licensing fees in the amount of $495.00. For your convenience, your PIN is 179679. Licensing Information System documents / billing were left at the facility regarding the due fees,the state’s words, verbatim · CDSS document, Sep 19, 2025

Type of visit: Case Management - Incident

LPA Johnson arrived at the facility to conduct a case management visits. R1 has been feeling unwell since Sunday, 06/21/2025. Since then, his appetite and fluid intake have significantly decreased. He was seen by his primary care physician, Dr. Malak, on 06/25/2025, and was prescribed medication for nausea. Upon returning home from the appointment, R1 appeared extremely weak. Staff had to assist him in walking to his room. He also experienced a bowel accident. After being cleaned up, he remained very weak, fatigued, and slow to respond to staff. Out of concern for his condition, 911 was called, and R1 was transported to Dameron Hospital. The facility is currently awaiting an update regarding his diagnosis and/or treatment plan.the state’s words, verbatim · CDSS document, Jun 30, 2025

Type of visit: Case Management - Other

LPA Johnson arrived at the facility to conduct a POC visits. The following deficiencies, initially cited during a visit on 10/24/2024, have been cleared:the state’s words, verbatim · CDSS document, Dec 18, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 122.9 degrees Fahrenheit in resident bathroom sink, which is not within the required range of 105 to 120 degrees. Fire extinguishers and carbon monoxide detectors are operational. LPA observed centrally stored medications are kept locked, however the hinges need to be replaced. (Advisory given) LPA reviewed and compared resident medication vs. resident medication logs. The facility used the wrong date packet of medication. The date of the packet started was 10/27/2024. The facility has the right dated medication for the week however, they used the wrong one. The medication are the same, but the start dates are wrong. (Advisory given) LPA reviewed 4 resident and 2 staff files, including criminal record clearances. During the file review LPA observed during the staff file review an expired first aid/CPR card for S1 and an expired ID for S1 as well. All staff are fingerprinted and cleared. First aid kit was checked and is complete. Deficiencies were cited pursuant to Title 22 rules and regulations, Health and Safety Codes. Exit interview conductedthe state’s words, verbatim · CDSS document, Oct 24, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Oct 25, 2024

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) 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). This requirement is not met as evidenced by: Based on LP'As testing of water temperatures in residents bathroom, LPA recorded temperatures of 122.5 degrees respectively the licensee did not comply with the section cited above in as the water temperature was not inside the approved approved varience of 105 to 120 degrees F which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 24, 2024

Plan of correction: The facility will adjust the water temperature today to the required temperature. The facility will conduct water temperature logs for one week to ensure the hot water temperature is within regulations and the hot water is properly circulated throughout the facility.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(c)(1) · Plan of correction due date: Oct 31, 2024

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by record review S1 has an expired first aid/CPR card. This poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Oct 24, 2024

Plan of correction: Administrator shall call the first aid vendor and requested a New Card or send by email proof. Administrator will send a copy of First Aid card to LPA. FAX (916) 263-4744

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA met with Bella and explained the purpose of the visit. Later joined by Joseph. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 127 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers and smoke detectors/carbon monoxide detectors are operational. LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 4 resident and 1 staff files, including criminal record clearances. All staff are fingerprinted and cleared. First aid kit was checked and is complete. No deficiencies were cited pursuant to Title 22 rules and regulations, Health and Safety Codes. Exit interview conductedthe state’s words, verbatim · CDSS document, Nov 6, 2023