Dignity Manor Senior Home

Type of visit: Required - 1 Year

On 07/16/26 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was greeted by Staff (S1) Elizabeth Vassell. LPAs was granted entry. 3 clients were present during inspection and then departed for Day Program. Administrator (A1) Camalah Kopacz arrived shortly after LPA’s arrival. LPAs 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. Freezer temperature was maintained at 0 degrees F and refrigerator temperature was maintained at 39 degrees F. Cleaning chemicals was observed stored and locked under kitchen sink. Fire extinguisher was observed with a service date of: 6/3/26. Fire drill last completed on 05/4/26. Clients' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature tested at a range of 107.2 to 109 degrees F in 3 bathrooms. Outside of facility toured. Side gates were self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Medications were checked and observed kept locked in medication cart. Clients’ MARS was reviewed. Carbon monoxide and smoke detectors were tested and observed to be operational. All clients’ file reviewed to have all the required documents. A sample of staff files and all clients’ files were reviewed and observed to have all the required documents. Exit Interview conducted. LPA is requesting the following documents be submitted to the Fresno CCL office by 7/30/26: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance-RCFE, Emergency and Disaster Plan (LIC 610E), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A) A copy of this report was provided to Administrator, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Jul 16, 2026

Type of visit: Required - 1 Year

On 07/16/25 Licensing Program Analysts (LPA) J. Leffall and L. Xiong arrived unannounced to conduct an Annual Inspection. LPAs introduced selves, stated the purpose of the visit, and was greeted by Staff (S1) Alecia Warburton. LPAs was granted entry. 5 clients were present during inspection and then departed for Day Program. Administrator Camalah Kopacz (A1) arrived shortly after LPA’s arrival. LPAs 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. Freezer temperature was maintained at 0 degrees F and refrigerator temperature was maintained at 37 degrees F. Cleaning chemicals was observed stored and locked under kitchen sink. Fire extinguisher was observed with a service date of: 7/1/25. Fire drill last completed on 05/19/25. Clients' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature tested at a range of 106.7 to 109.5 degrees F. in all 3 bathrooms. Outside of facility toured. Side gates were self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Medications were checked and observed kept locked in medication cart. Clients’ MARS was reviewed. Carbon monoxide and smoke detectors were tested and observed to be operational. All clients’ file reviewed to have all the required documents. A sample of staff files and all clients’ files were reviewed and observed to have all the required documents. No deficiencies issued during this inspection. Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 07/30/25: Lic 308, Lic 500, Lic 610D, and Lic 9020. LPA received a copy of current Administrator certificate. A copy of this report was provided to S1, whose signature on this form confirms receipt of these report.the state’s words, verbatim · CDSS document, Jul 16, 2025

Allegation investigated: Staff neglect resulted in resident developing maggots in the mouth

On 3/6/225 at 1:15pm Licensing Program Analyst (LPA) J. Leffall conducted a subsequent complaint visit to deliver findings on above allegations. LPA met with Licensee (L1) Camala Kopazz and stated purpose of visit. The department conducted interviews and reviewed records. Based on the information obtained, the above allegation is unsubstantiated. Exit interview conducted. A copy of this report was provided to Licensee, whose signature on this form confirms receipt of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 6, 2025 · control 24-AS-20241219120418

Type of visit: Required - 1 Year

On 08/23/24 Licensing Program Analysts (LPA) J. Leffall and L. Xiong arrived unannounced to conduct an Annual Inspection. LPAs introduced selves, stated the purpose of the visit, and was greeted by Staff (S1) T. Brownwebb. LPAs was granted entry. 5 clients were present during inspection. Licensee (L1) Camalah Kopacz (L1) arrived shortly after LPA’s arrival. LPAs toured facility with L1. 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. Freezer temperature was maintained at 0 degrees F and refrigerator temperature was maintained at 37 degrees F. Cleaning chemicals was observed stored and locked under kitchen sink. Fire extinguisher was observed with a service date of: 5/21/24. Fire drill last completed on 08/6/24. Clients' bedrooms were toured and 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 105 degrees F. in all 3 bathrooms. Outside of facility toured. Side gates were self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Medications were checked and observed kept locked in medication cart. Clients’ MARS was reviewed. Based on observation Medication 1 (M1) should have 52 tablets. LPA counted 48 tablets. Tablets were 4 short which poses an immediate health, safety or personal rights risk to persons in care. Also, Medication 2 (M2). Medication count should be 89 tablets. LPA’s counted 76 tablets. Tablets were 13 short which poses an immediate health, safety or personal rights risk to persons in care. Carbon monoxide and smoke detectors were tested and observed to be operational. All clients’ file reviewed to have all the required documents. A sample of staff files and all clients’ files were reviewed and observed to have all the required documents. The following deficiency is in violation of Title 22 CCR. Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 09/6/24: Lic 308, Lic 500, Lic 610D, and Lic 9020. LPA received a copy of current Licensee certificate. A copy of this report was provided to Licensee and Executive, whose signature on this form confirms receipt of these report.the state’s words, verbatim · CDSS document, Aug 23, 2024