Dignity Gardens Home II

Type of visit: Required - 1 Year

On 5/14/2026, Licensing Program Analyst (LPA) J. Leffall 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 (S1) D. Forbes. Administrator (A1) Camalah Kopacz arrived shortly after LPA’s arrival. 4 residents were present during visit. 2 residents reside at this location and the other 2 reside at Dignity Gardens Home #1. They are temporarily residing in this location because of renovations taking place at Dignity Gardens #1. A1 states residents will reside here until or before 6/1/26. LPA toured facility with A1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Samples of resident’s medications were observed locked in kitchen cabinet. Clients’ MARS was reviewed with samples of resident’s medications. Fire extinguisher reviewed with a service date of: 5/22/25. Fire drill completed on 3/24/26. Clients' bedrooms were toured and reviewed. Cleaning chemicals were observed stored and locked in closet. Residents bedrooms observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at a range of 111.9 to 113.1 degrees in 2 bathrooms. 2 insects found in the bathroom while water temperature was being tested. Outside of facility toured. Outside observed free of debris. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Freezer temperature observed at 0 degrees F and refrigerator temperature maintained at 37 degrees F. Smoke detectors and carbon monoxide were tested and observed to be operational. All clients’ files and staff’s files reviewed to have all the required documents. Medications and MAR’s reviewed. 1 resident’s medications found accessible in unlocked drawer in the kitchen. Continued on LIC-809C The following deficiencies is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. Exit Interview conducted. LPA is requesting the following documents be submitted to the Fresno CCL office by 5/28/26: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E ), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A-RCFE) A copy of this report with Appeal rights were provided to A1, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, May 14, 2026

Allegation investigated: Staff hit resident

On 6/5/25 at 2:30 pm Licensing Program Analyst (LPA) J. Leffall conducted an initial complaint visit to open and to deliver findings on above allegation. LPA met with Administrator Camalah Kopacz. The Department conducted an interviews with facility staff Administrator and resident. R1 stated likes living at facility and does not have any issues with staff. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. No deficiencies were issued. Exit interview conducted. A copy of this report was distributed to Adminsitrator which confirms signature of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 5, 2025 · control 24-AS-20250603132231

Type of visit: Required - 1 Year

On 5/21/2025, Licensing Program Analyst (LPA) J. Leffall 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 (S1) Shannagaye Smith. Administrator (A1) Camalah Kopacz arrived shortly after LPA’s arrival. 4 residents were present during visit. LPA toured facility with S1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Samples of resident’s medications were observed locked in kitchen cabinet. Clients’ MARS was reviewed with samples of resident’s medications. Fire extinguisher reviewed with a service date of: 5/18/25. Fire drill completed on 3/10/25. Clients' bedrooms were toured and reviewed. Cleaning chemicals were observed stored and locked in closet. Residents bedrooms observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at 108.1 degrees in 2 bathrooms. Outside of facility toured. Outside observed free of debris. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Freezer temperature observed at 0 degrees F and refrigerator temperature maintained at 38 degrees F. Smoke detectors and carbon monoxide were tested and observed to be operational. All clients’ files and staff’s files reviewed to have all the required documents. No deficiencies issued during this inspection. Exit Interview conducted. LPA is requesting the following documents be submitted to the Fresno CCL office by 6/4/25: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E ), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A-RCFE) A copy of this report was provided to A1, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, May 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Licensee, Camalah Kopacz Continual Administrator's Certification expires 05/11/2025. There are currently 5 residents who reside at this home and there is 2 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 118.5 degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. LPA interviewed 3 residents, and two facility staff. LPA reviewed staff and resident files. LPA Hurt confirmed all staff present is background cleared. Resident 1's medication is not documented correctly on the facilities Centrally Stored Medication Log. The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Licensee, Camalah Kopacz, and copy of report left at facilitythe state’s words, verbatim · CDSS document, May 18, 2024