Ebadat Residential Care Home # 5

Allegation investigated: Facility staff argued with one another in the presence of residents in care.

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced initial complaint investigation. LPA met with Designated Staff Aileen Calicdan and Administrator (ADM) Aaron-Dell Coronel. LPA stated the purpose of the visit. It has been alleged that facility staff argued with one another in the presences of residents in care. During today's visit, LPA interviewed 4 Staff (S1 to S4), and 2 Residents (R1 to R2). 4 Out of 4 staff stated facility staff argued in the presence of residents in care on 8/9/2026. S4 stated Staff S3 and S5 argued with one another in the presence of residents in care on 8/9/2026. S4 stated he/she is aware that S5 had threatened to kill S3 while in the presence of residents in care. Page 1 of 2 Substantiated S3 stated on 8/9/2026, he/she and S5 were providing care to a resident, when his/her foot was injured/hurt by S5. S3 stated he/she told S5 to be careful, and S5 began to argue with S3, with S5 stating to S3 that he/she would 'kill' him/her. S3 stated facility management was informed of this incident, and he/she was told by facility management that S5 would be transferred to another facility due to this incident. S3 states S5 is still working at the facility. LPA interviewed 2 Residents (R1 to R2). Resident R1 stated he/she has heard that S5 threatened to kill another staff member about two weeks ago. R1 stated he/she has heard S5 yelling at staff, that S5 yells that staff 'are not doing their job." R2 stated he/she did not have any issues or concerns. Based on interviews conducted the preponderance of evidence standard has been met, therefore the above allegation(s) is/are found to be SUBSTANTIATED. California Code of Regulations (Title 22), are being cited on the attached LIC 9099 D. An exit interview was conducted with the ADM Aaron-Dell Coronel and copy of this report was provided. Appeals rights also provided. Page 2 of 2 END OF REPORTthe state’s words, verbatim · CDSS document, Aug 21, 2026 · control 26-AS-20260814153052

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Aug 22, 2026

87468.1 Personal Rights of Residents in All Facilities (a) (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews conducted, Staff S3 and S5 argued with one another in the presence of residents in care on 8/9/2026, with S5 threatening to kill S3. This poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 21, 2026

Plan of correction: ADM states he will submit a plan of action to ensure staff are treating residents with dignity and respect, to include an all staff training regarding personal rights. POC to be submitted to CCL by POC due date 8/22/2026.

Type of visit: Case Management - Other

LPA Maria Mita Partoza, conducted an unannounced case management visit and met with Administrator Aaron Dell Coronel. LPA stated the purpose of the visit. On 10/24/25, LPA Mita Partoza amended the LIC 9099, that inadvertently contained a confidential information for complaint #26-AS-20250422154952. The report has been amended and reviewed by the administrator. No deficiencies were cited during today's visit based on California Code of Regulations (CCR) Title 22. A copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 24, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced required 1 year visit and met with administrator (ADM) Aaron-Dell Coronel. LPA stated the purpose of the visit. The facility is licensed to serve adults 18 to 59 years old who are developmentally challenged, ambulatory and non-ambulatory. At 1:10 p.m LPA inspected the facility inside and outside and was accompanied by ADM. LPA observed that all exit doors, walkways, ramps and hallways were free from obstruction. The backyard was well maintained an no debris were observed. LPA inspected the kitchen, dining, living room, 4 resident bedrooms, 2 bathrooms, laundry room and garage. LPA observed no obstruction on the hallways, night lights were available to illuminate the hallways. 2 Out of the 4 bedroom are shared and 2 Out of the 4 are not shared. The bathrooms are equipped with grab bars and non-skid mats. Each bedroom bedding, are sanitary and organized, has sufficient storage to store resident's personal belongings and functioning lights. 2 of the resident beds observed with half bed rails that were prescribed by their primary care physician for the safety of the resident. The facility has a room temperature of 70 degree F, water temperature measured at 112.4 to 113.4 degree F. The refrigerator temperature is at 37 degree F and freezer temperature is at -3 degree F. page 1 of 2 In the kitchen, LPA observed that sharps, medications, are not accessible to residents in care. LPA observed 2 days of perishable items in 7 days of non-perishable items. LPA did not observed any food on the counters that were exposed and no open cartons of food stored. LPA observed that cleaning supplies, and laundry supply are not accessible to residents in care and stored separately from the food storage. LPAs observed first aid kit was complete. Facility has flashlights and batteries. LPA observed the fire extinguisher was last serviced on 08/11/2025. Fire extinguisher was inspected by the vendor on 08/11/2025 and the fire alarm is connected to the fire department. Smoke and carbon monoxide - are in good working condition. The facility disaster preparedness training was conducted on July 29,2025, Fire drill was conducted on August 18, 2025 and earthquake drill was conducted on July 14, 2025. 3 resident records were reviewed and verified to be complete and up to date. LPA reviewed the admission agreement, physician's report, TB result, appraisal needs and services plan and individual program plan, identification and emergency contact information, safeguard of personal properties and valuables, personal rights, and consent forms the centrally stored medications and destruction record and personal and incidental allowance. 3 staff record was reviewed and was verified to be complete and up to date such as but not limited to 1st aid/CPR training, personal rights of the residents, health screening, medical training and Statement Acknowledging Requirement to report Suspected Abuse of Dependent Adults and Elders (SOC341A), fingerprint and background clearance. LPA requested the following documents from ADM - LIC500 (Personnel Report) Liability Insurance, designation of responsibility (LIC308) and Lease Agreement. No deficiencies were cited during today's visit based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with administrator, Aaron Dell Coronel and a copy of this report were provided. page 2 of 2 end of reportthe state’s words, verbatim · CDSS document, Sep 30, 2025

Allegation investigated: RSO is present in the facility.

*On 10/24/25, LPA Maria (Mita) Partoza, amended the report to remove confidential information that was inadvertently included on the previous report.* Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to deliver the finding for the above allegation. LPA met with Administrator, Aaron Dell Coronel. On 04/22/2025, the Department received a complaint with the above allegation. On 04/23/2025, the initial investigation was conducted. Based on review of the facility’s roster and interview; Individuals involved with residents' have cleared fingerprint and have cleared background information, no record of criminal act including the registered sex offender (RSO) registry was found. This agency has investigated the complaint alleging RSO is present in the facility and found that the complaint was unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. No deficiencies were cited per California Code of Regulations (CCR), Title 22. This report was reviewed with Administrator, Aaron Dell Coronel and a copy of the amended report was provided. Unfoundedthe state’s words, verbatim · CDSS document, Sep 19, 2025 · control 26-AS-20250422154952

Type of visit: Case Management - Other

On 4/23/2025 LIcensing Program Analyst (LPA) Santino Fortes and Licensing Program Manager (LPM) Romeo Manzano made an unannounced visit to open a Personal rights complaint with ADM Aaron Coronel. During visit there were 5 staff and 6 residents observed. During inspection visit, LPA and LPM arrived at the facility at 8:15am and met with 3 staff (S1-S3) in the dining/kitchen area. Five residents (R1-R5) were observed in the living room watching TV with Staff(S4). Staff stated breakfast service had just finished. LPA/LPM met with R6 at approximately 9am. While LPA and LPM were in the kitchen/dining area, deficiencies were observed and being cited during today's visit, see LIC809-D. The following deficiencies were observed as follows: Resident restrained in wheelchair by a strap. Medications are found accessible in a brown observed on top of an office table (against the wall on the left facing the street) in the main dining room accessible to residents in care. Staff S1-S3 stated that it belongs to 4 residents, R1 to R4. Staff stated that the medications were received last week and have not been logged to the Centrally Stored Medication form for May 2025. Staff were aware that medication has to be locked but when asked why medications were on top of the table unlocked, they were not able to provide an answer. Staff were not administering medication during LPA/LPMs arrival or visit at the facility. LPA/LPM observed that the centrally stored medication cabinet next to the coffee machine/stove was unlocked. Staff/ADM agreed that medication cabinet must be locked at all times. LPA/LPM also provided guidance of the importance of keeping medication inaccessible residents. LPM provided guidance Title 22, Code Section 80075 Continuation on page, 2 of 2 (LIC809 C) A defrosted meat (pork chops) was observed sitting on top of the fire place brick left overnight since 7pm (4/22) per S1 to S3. Staff stated that it belongs to Staff (S5) The facility serves residents with developmental disabilities, 1 of which has a behavior of consuming anything that could potentially a choking hazard (R1) LPA/LPM also provided guidance in the importance of food handling and storage. LPM provided guidance Title 22, Code Section 80076. During LPA/LPMs tour of the facility, R1 was observed in the living room area while seated on a wheelchair with a gait belt 'tied' around his/her waist. Staff and ADM state that R1 and R2 requires a seat belt to prevent them from sliding or falling. R1 and R2 does not have the ability and capacity to unlocked belt in case of an emergency. On the other hand, staff also stated that R2 also requires a seat belt when in wheelchair. LPA/LPM observed that R2 also utilized gait belt (blue in color). ADM stated gait belts were given to them by a physical therapist to help residents with ambulation but not to utilized as a seat belt. There are no physician's order on residents' file to utilize gait belt as a seat belt. LPM provided guidance Title 22, Code Section 80072 During interview with ADM regarding his work schedule, ADM stated that he visits or monitor facility five (5) days week from 1:00PM to 4:00PM. LPA/LPM also discussed about the importance of ADM's physical presence in the facility at least 20 hours a week during business hours, Monday to Friday, 8:00AM to 5PM. ADM also oversees another RCFE. LPA/LPM informed ADM to submit an updated LIC500 Personnel Summary to CCL by close of business on 4/25/25. ADM is also advised to call caseload LPA and/or Desk Duty Officer, if needed. LPA/LPM also conducted a random review of residents' files. LPA/LPM also suggested that Appraisal Needs and Services need to be accurate in line with residents' IPP (Individual Program Plan) and kept up to date with resident behaviors not in the IPP. ADM agreed and understood. LPA also discussed about CCLD's Technical Support Program (TSP). LPA informed ADM that TSP is voluntarily but it will beneficial for keep facility in compliance with Title 22 regulations and can be accessed on the CCLD website. The following deficiencies were cited per CA Code of Regulations Title 22- refer LIC809-D. Appeal Rights information were provided and discussed with ADMthe state’s words, verbatim · CDSS document, Apr 23, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80072(a)(8)(C) · Plan of correction due date: Apr 24, 2025

Personal Rights (a)(8)(C):Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to...(8)Not to be placed in any restraining device.Postural supports may be used under the following conditions:(C) Postural supports shall be fastened or tied in a manner which permits quick release by the client. This requirement is not met as evidenced by: Based on inspection and observation, (See continuation on next column, under Plan of Correction)the state’s words, verbatim · CDSS document, Apr 23, 2025

Plan of correction: Continuation: R1 was observed seated in wheelchair tied with a gait belt and staff also stated they use gait belt for R2 which poses an immediate Health, Safety or Personal Rights risk to residents in care. ADM stated that he will provide a written plan of action by POC date 4/24/2025.

From the deficiency page — Section cited: CCR80076(13)(14) · Plan of correction due date: Apr 24, 2025

Food Services(13)(14): All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination. (14)All foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at 45 degrees F (7.2 degrees C) or less. This requirement is not met as evidenced by the observation of a package of raw meat left tothe state’s words, verbatim · CDSS document, Apr 23, 2025

Plan of correction: Continuation: defrost on the main dining table since the prior day, which poses an immediate Health, Safety or Personal Rights risk to residents in care. ADM stated that he will provide food service training for food preparation and storage by POC date 4/24/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80075(k)(1) · Plan of correction due date: Apr 24, 2025

Health Related Services(k)(1):The following requirements shall apply to medications which are centrally stored(1)Medication shall be kept in a safe and locked place that isnot accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation, medications are found accessible in a brown observed on top of an office table (against the wall on the left facing the street) in the main dining room which belongs. (See continuation on next column, under Plan of Correction)the state’s words, verbatim · CDSS document, Apr 23, 2025

Plan of correction: Continuation: to R1 to R4, which poses an immediate Health, Safety or Personal Rights risk to residents in care. ADM stated that he will conduct a staff in service training on medication such as but not limited to storage and recording/logging in the centrally stored medicaiton log by POC date 4/24/25.

Allegation investigated: Facility staff physically abused a resident

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to deliver the finding for the above allegation. LPA met with staff, Raul Santos. Administrator, Aaron-Dell Coronel was not feeling well and was unable to meet LPA at the facility. On 01/29/2025, the Department received a complaint alleging that facility staff (S1) physically abused a resident (R1). On 01/30/2025, the initial complaint investigation was conducted. The following documents were obtained to include resident (R1)’s physician's report, IPP, emergency form, appraisal/needs and services plan, preplacement appraisal, and police incident card. Page 1 of 2. Unfounded It was alleged that on January 11, 2025 R1 was hit by a staff member (S1). 3 staff members were interviewed. Based on staff interviews, it was stated that on January 11, 2025, staff (S2) was assisting R1 in the bathroom when R1 began getting physical with S2. While S2 was assisting R1, R1 defecated on the bathroom floor and asked staff (S1) for assistance. S1 stepped in to assist S2 while R1 was getting physical by swinging his/her hands and hitting the staff. S1 states that during the incident you could hear R1's hands hit the counter and toilet. For R1's safety, S1 was trying to move R1 to the toilet and once he/she sat on the toilet, both staff left the area to allow R1 to calm down. S1 states the situation became really loud because R1 was screaming. 2 out of 2 staff (S1 and S2) who were part of the incident denied physically abusing R1. Staff conducted a body check, where staff observed R1 sustained a scratch on his/her chin and small bruise on his/her finger from R1 swinging his/her arms. There were no other bruises observed throughout R1's body. A resident at the facility was interviewed. Based on interview, the resident only heard yelling coming from the bathroom during the incident. Resident denied staff hurting him/her and denied physically seeing staff hurt R1. Resident (R1) was interviewed, who denied staff physically hurting him/her at the facility. Staff stated that R1 has many incidents with telling lies. The review of R1’s records corroborates this statement. The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unfounded, meaning the allegation is false, could not have happened and/or is without a reasonable basis. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with staff, Raul Santos and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 9, 2025 · control 26-AS-20250129160852

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcela Yanez and Christine Dolores conducted an unannounced Required 1 Year visit and met with Aaron Dell Coronel Administrator. During visit, LPAs toured the facility inside and out with staff. 4 resident's observed in the living room area. 5 staff observed present are fingerprint cleared and associated to facility. LPAS toured the outside area and found the exits to be clear of obstructions. LPAs entered the garage area and observed cabinets of non-perishable foods and locked cabinets for cleaning supplies. LPAs observed the garage has a built-in storage room located to the back left of the garage, which the Licensee states was installed about 2 months ago. Licensee states the fire Department visited the facility and stated a permit is not needed as the purpose of the room is for storage. Facility temperature maintained at 74 degrees F. LPA observed the kitchen area and observed locked cabinets for medications and sharp objects. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days. Refrigerator temperature maintained at 37 degrees F and freezer temperature maintained at -3 degrees F. LPA entered 3 resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. 2 resident beds observed with full bed rails. LPA toured one resident bathroom. Resident bathroom had available soap, paper towels and functioning lights. Shower equipped with grab bars and non-slid mats. The water temperatures in the bathroom sink measured using a thermometer at 158.0 degrees F. Licensee adjusted the water heater during visit and LPAs measured the hot water temperature using a thermometer to be at 112.1 degrees F. LPAs observed first aid kit was complete. Facility has flashlights and batteries. LPA observed the fire extinguisher was last serviced on 10/26/2024. Carbon monoxide detector present. LPA reviewed Fire and Earthquake drills was last conducted on 07/2024. Page 1 of 2. Page 2 of 2 3 resident records were reviewed and observed complete to include the admission agreement, physician's report, TB result, updated needs and services plan and/or IPP, identification and emergency contact information, safeguard of personal properties and valuables, personal rights, and consent forms. 3 residents centrally stored medications and P&I money observed maintained. Based on record review, 2 resident's who are using full length bed rails does not contain a physician's order for full length bed rails. LPAs observed the physician's orders states the use for side rails, but the order did not indicate if the side rails were for half or full. LPAs reviewed the facility file and the facility did not submit an exception request for the use of full length bed rails. Based on record review, 2 resident's appraisal/needs and services plan and IPP did not include the need for full length bed rails. LPA reviewed 3 staff records and found them to be complete to include a health screening, TB result, job application, fingerprint clearance and 1st aid certification. 3 staff files contains at least 20 hours of annual training. Documents were requested to LPA Dolores by 10/17/2024: - LIC500 (Personnel Report) - Liability Insurance - Lease Agreement Deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Administrator, Aaron-Dell Coronell and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 16, 2024

Allegation investigated: Facility staff physically abused resident

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the finding for the above allegation. LPA met with Administrator, Aaron-Dell Coronel. On 08/15/2023, the department received the complaint. On 08/23/2023, the initial complaint investigation was conducted. The following documents were obtained to include resident (R1)’s face sheet, physician’s report, and IPP. It was alleged that R1 reported that the facility staff physically abused R1. PAGE 1 OF 2. Unfounded On 08/23/2023, 3 staff members were interviewed. Based on interview, 3 out of 3 staff denied physically abusing R1. It was stated that after a meeting with R1, R1’s day program staff, service coordinator and facility staff, R1 admitted on telling a lie. On 08/23/2023, 2 witnesses were interviewed. Based on interview, 2 out of 2 witnessed stated that after meeting with R1 at the facility, R1 admitted to telling a lie. On 08/23/2023, R1 was interviewed. Based on interview, R1 denied facility staff hurting R1. R1 admitted to lying about staff hurting R1. R1 stated to feel safe at the facility. Based on record review, R1 has a history of lying as a means of getting attention. The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unfounded, meaning the allegation is false, could not have happened and/or is without a reasonable basis. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Aaron-Dell Coronel and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 11, 2024 · control 26-AS-20230815111504

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the complaint finding for complaint control number: 26-AS-20230815111504. During visit, a violation was observed prompting a case management visit. LPA met with Administrator, Aaron-Dell Coronel. During visit, LPA observed a staff (S1) who is not fingerprint cleared. Based on record review, S1 has a request for live scan form dated May 2024 and DOJ Applicant fingerprint Response dated May 16, 2024. LPA Dolores used the Guardian system to search for S1’s background check. The search results stated, “no applicants that match your search criteria were found in the background check system”. LPA also called the Licensing office and confirmed with a support staff that S1 does not have a background check application. Based on an interview with the Administrator, the Administrator thought the “DOJ Applicant fingerprint Response” was the background check clearance. LPA did not observe S1 received a clearance notification from the Department. LPA advised Administrator to verify staff’s fingerprint clearance through Guardian or by calling the Licensing office to confirm. Administrator stated understanding. A deficiency was cited per California Code of Regulations, Title 22. See LIC809-D. A civil penalty was assessed for the amount of $500 ($100 x 5 days = $500) for S1 working in the facility without a fingerprint clearance. This report was reviewed with Administrator, Aaron-Dell Coronel and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 11, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80019(e)(2) · Plan of correction due date: Sep 12, 2024

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by: Based on interview, record review and observation the licensee did not ensure staff (S1) obtained a fingerprint clearance from the Department prior to working in the facility which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 11, 2024

Plan of correction: Licensee plans to request another live scan for S1. Licensee will submit a written plan when verifying new staff's personnel records to include their fingerprint clearance, to LPA Dolores via email by POC due date.

Allegation investigated: Staff are not properly trained to care and supervise resident with a restricted health condition

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to open the initial complaint investigation. LPA met with Administrator (ADM), Aaron-Dell Coronel. On 05/13/2024, the Department received a complaint alleging that staff are not properly trained to care and supervise resident with a restricted health condition. On 05/17/2024, the initial complaint investigation was conducted. The following documents were obtained to include resident (R1)’s physician’s report, functional capabilities, IPP, restricted health condition care plan, staff training, exception request, and medical records. On 05/07/2024, resident (R1) was discharged from the hospital with a restricted health condition. PAGE 1 OF 2. Substantiated Based on interview, on 05/07/2024 around 5:00PM the ADM was notified of the restricted health condition when R1 was already in the ambulance en route back to the facility from the hospital. The ADM immediately contacted a home health agency to provide training to staff. Based on record review the training with the home health agency was completed on the same day. On 05/08/2024 around 4:00PM – 5:00PM, R1’s responsible party through San Andreas Regional Center (SARC) was contacted; however, ADM did not speak with SARC until 05/09/2024. On 05/09/2024, the facility was instructed to create an urgent restricted health condition care plan. Based on record review, on 05/09/2024 the restricted health condition care plan was completed by the facility nurse consultant and pending approval by SARC. On 05/15/2023, the facility was pending additional documentation to SARC. On 05/16/2024, the additional documentation was submitted and the restricted health condition care plan was approved. As of today’s visit, of 05/17/2024, the facility’s nurse consultant has not yet completed the staff training on R1’s restricted health condition care plan. ADM states the plan for the facility’s nurse consultant to complete the training, ASAP. The Department has investigated the above allegation. Based on interview, record review, and observation the preponderance of evidence standard has been met, therefore, the above allegation is substantiated. A deficiency was cited per California Code of Regulations, Title 22. SEE LIC9099-D. Advisory note provided. This report was reviewed with Administrator, Aaron-Dell Coronel and a copy of the report and appeal rights were provided. PAGE 2 OF 2.the state’s words, verbatim · CDSS document, May 17, 2024 · control 26-AS-20240513090627

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87613(a)(1) · Plan of correction due date: May 18, 2024

(a) Prior to admission of a resident with a restricted health condition, the licensee shall: (1) Communicate with all other persons who provide care to that resident to ensure consistency of care for the condition. This requirement is not met as evidenced by: Based on interview, record review, and observation the licensee did not ensure to immediately communicate with the appropriate agencies responsible for R1’s care to ensure a restricted health condition care plan was in place upon being notified of R1's restricted health condition which poses an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 17, 2024

Plan of correction: Licensee plans to submit R1's restricted health condition care plan training to LPA by POC due date. Licensee will also submit a statement of understanding of the section cited. POC will be sent to LPA Dolores via email by POC due date .

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's required 1 year inspection. LPA met with Administrator, Aaron Coronel. ADM started at the facility on 09/15/2023 and states he is still working on getting the facility back in compliance. During visit, LPA toured the facility with ADM to include the entrance, living room, resident bedrooms, staff bedroom, bathroom, kitchen, dining room, garage, and backyard. LPA observed there was a shed in the backyard. ADM did not have a key to the shed, therefore, LPA was unable to observe the inside of the shed. All fire exit routes are free and clear of obstruction. Facility temperature maintained at 72 degrees Fahrenheit. Fire extinguisher last services on 06/16/2023. Facility has at least one carbon monoxide detector located in the kitchen. Facility has a fire alarm pull system. Staff state they have not had an inspection from the fire department. Upon entrance, LPA observed a sign-in sheet, masks, hand sanitizers, and COVID-19 related posters. Additional signs were observed to include resident's personal rights, emergency disaster plan, infection control plan, emergency contact numbers, and activities calendar. LPA entered 3 resident bedrooms which contains 2 beds in each room. All resident bedrooms contained a bed, dressers, closet space, clean linens, and lighting. LPA observed residents R4 and R5's bed contains full length bed rails. The physician's order on file states an order for "side rails". ADM will confirm with the physician if full-length bed rails are needed. R4 - R5 are not receiving hospice care services. ADM was informed that an exception request is needed if R4 - R5 requires full-length bed rails. Bathrooms equipped with toilet paper, soap, and hand washing sign. Shower equipped with a shower chair, non-slip mat, and grab bars. Hot water temperature maintained at 126 degrees Fahrenheit. SEE LIC809-C. Kitchen is supplied with 2 days worth of perishables and 7 days worth of non-perishable foods. Items in the refrigerator observed covered. Refrigerator temperature maintained at 38 degrees Fahrenheit. Freezer temperature maintained at -2 degrees Fahrenheit. Sharp objects, chemicals, and disinfectants observed locked. Medication cabinet located in the kitchen observed locked. Facility has emergency telephone numbers posted at the front door. Each residents files contains an emergency information face sheet. LPA observed a complete first aid kit. Facility has emergency lighting and extra batteries. Staff has not conducted and documented quarterly emergency disaster drills. ADM was advised. PPE supplies observed to include gowns, shields, gloves, masks, disinfectants, and hand sanitizer. LPA reviewed 4 resident records. 4 out of 4 resident records contained an admission agreement, physician's report, and TB result. R1 - R4's file contained an IPP. R1's IPP was last updated in 2020, R3's IPP was last updated in 2019, R4's IPP was last updated in 2021. ADM was advised. ADM is currently working on updating appraisal/needs and services plan. ADM states he can get them done by 10/20/2023. Residents who require a wheelchair does not have a weight record on file because the facility does not have the equipment to weigh residents in a wheelchair. Facility has collaborated with home health agency to obtain the weight record for residents in a wheelchair. 4 out of 4 residents centrally stored medication records and P&I money were reviewed. LPA observed each resident has a PRN medication log. LPA reviewed 4 staff files. Current staff obtains a first aid certification, fingerprint clearance, health screening, and TB result. ADM obtains a current Administrator Certificate. Staff training records were reviewed. LPA did not observe staff were provided an annual 20 hours of training to include topics about dementia, postural supports, restricted health conditions, and hospice care. The following documents were obtained: LIC-610E, LIC-9282, LIC-308, and liability insurance. ADM will email LPA the LIC-500 by 10/11/2023. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Administrator Aaron Coronel and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 10, 2023