D Hillside Place II

Type of visit: Required - 1 Year

At approximately 9:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Johnny Copero and explained the purpose of the visit. Administrator certificate is current. Facility has a Hospice waiver for 2 residents. At approximately 9:15AM, LPA toured the facility to ensure the health and safety of residents in care. The facility was observed to be at a comfortable temperature. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. LPA observed night lights in the hallways. The kitchen equipment was clean and in good repair. Dishware appeared to be stored in a sanitary manner. Food appears to be stored and prepared properly. Refrigerators and freezers were maintained at the proper temperature. Facility has required seven-day non-perishable and two-day perishable supply of food. Emergency food stores and water was present to ensure facility can be self-sufficient for 72 hours. Emergency lighting devices were present. First aid kit was present. No pools/bodies of water are on the premises. Facility has been conducting Emergency drills every 3 months. At approximately 9:45AM, LPA reviewed 6 of 6 resident files. All resident files were well organized. Reappraisals were conducted within the last 12 months in 6 of the 6 files reviewed. Documentation of a physician visit within the last 12 months was present. Medication records were organized and contained orders for each medication. Resident medications were secured in a locked cabinet, however the lock was not engaged. Staff were present near the cabinet while it was unsecured. LPA observed staff medication was in a locked container in the refrigerator in the kitchen. Continued on LIC809-C... At approximately 10:30AM, LPA reviewed 6 staff files. Staff files reviewed contained evidence of completed annual training. First Aid/CPR certification was current. All employees requiring background checks are cleared. Updated copies of the following documents were received during this visit: LIC 9020 Register of Residents LIC 610 Emergency Disaster Plan LIC 500 Personnel Report Evidence of Liability insurance No deficiencies were observed in the areas inspected, No citations were issued during today’s visit.the state’s words, verbatim · CDSS document, Aug 3, 2026

Type of visit: Required - 1 Year

At approximately 9:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Caregiver Yvonne Silva and explained the purpose of the visit. Administrator certificate is current. Facility has a Hospice waiver for 2 residents. At approximately 9:15AM, LPA toured the facility to ensure the health and safety of residents in care. The facility was observed to be at a comfortable temperature. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The kitchen equipment was clean and in good repair. Dishware appeared to be stored in a sanitary manner. Food appears to be stored and prepared properly. Refrigerators and freezers were maintained at the proper temperature. Facility has required seven-day non-perishable and two-day perishable supply of food. Emergency food stores and water was present to ensure facility can be self-sufficient for 72 hours. Emergency lighting devices were present. First aid kit was present. All employees requiring background checks are cleared. No pools/bodies of water are on the premises. Facility has been conducting Emergency drills every 3 months. At approximately 9:45AM, LPA reviewed 6 of 6 resident files. All resident files were well organized. Reappraisals were conducted within the last 12 months in 4 of the 6 files reviewed. Documentation of a physician visit within the last 12 months was present. Medication records were organized and contained orders for each medication. Resident medications were secured in a locked cabinet. LPA observed staff medication unsecured in both refrigerators in the kitchen. Continued on LIC809-C... At approximately 11:40AM, LPA reviewed 5 staff files. Staff files reviewed contained evidence of completed annual training. First Aid/CPR certification was current. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC308- Designation of Responsibility Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Johnny Copero and Appeal rights were given.the state’s words, verbatim · CDSS document, Sep 2, 2025

Allegation investigated: Insufficient staff to meet residents' needs. Staff are not meeting resident's toileting needs. Staff do not serve nutritious meals.

Licensing Program Analyst (LPA) A. Canela arrived unannounced to continue complaint investigation regarding the allegations listed above. LPA obtained documents, made observations and took statements. It was alleged there is Insufficient staff to meet residents' needs, Upon arrival there were 2 staff and 6 residents, of which 2 of the residents R1 and R2 do not require any assistance. Administrator was called and arrived a few minutes later. Residents interviewed did not corroborate allegation and stated the facility staff provide assistance and there is usually 2-3 staff. It was also alleged staff are not meeting resident's toileting needs. LPA conducted interviews with staff who stated they assist residents and residents are never left in soiled garments. LPA did not get any corroborating statements from residents. Continue report see LIC9099-C Unsubstantiated Report continued from LIC9099: It was also alleged staff do not serve nutritious meals. LPA went over facilities menu plan and took pictures of food items in the refrigerator and freezer. Food items observed included, vegetables, fruits (blueberries), different milks including oat milk, protein drinks, sausage; deli meats, beef, pork and chicken. LPA did not get any corroborating statements from residents. Based on LPAs observations record review and statements received allegations for: Insufficient staff to meet residents' needs, Staff are not meeting resident's toileting needs & staff do not serve nutritious meals; are all UNSUBSTANTIATED at this time. An UNSUBSTANTIATED finding means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. No deficiencies cited during today's visit.the state’s words, verbatim · CDSS document, Dec 11, 2024 · control 21-AS-20240807215323

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual Required 1 Year inspection and met with Administrator Johnny Copero. This facility is licensed for 6 Non-ambulatory residents with a Hospice Waiver approved for 1 of the residents and no Bedridden approval. There were 6 residents and 2 staff on site at the time of inspection. LPA and Administrator toured the facility and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Residents' rooms were furnished per regulation. Water temperature in bathrooms used by residents is within the required range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Closet containing cleaning supplies was locked. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored and locked. Facility maintains emergency food and water supplies. Fire extinguishers were fully charged and last serviced May 1, 2024. Smoke and Carbon Monoxide detectors located throughout the facility were tested and operational. Most recent disaster drill was conducted 08/16/2024. Staff have required First Aid and CPR certificates. Johnny "Juanito" Copero filed for renewal of Administrator's Certificate. Required postings were observed. Medication records were reviewed. Continued on 809-C Five staff files and five resident files were reviewed. All were complete. Residents with dementia diagnoses had current Physician's Reports. Files were very well organized. The back yard provides nice areas for residents to sit and watch the birds at the bird feeder. Fencing in the back yard is being repaired/replaced on September 22, 2024. LPA interviewed three residents who stated that they liked the facility and were well-cared for. Licensee/Administrator submitted the following: LIC 500 Personnel Summary- LIC 610 Emergency Disaster Plan Copy of Liability Insurance Administrator to submit photos of new fence upon completion. No deficiencies were found at the time of inspection. No citations were issuedthe state’s words, verbatim · CDSS document, Sep 17, 2024