Elder Creek Villa II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with Maxie Hamilton for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 02:00 PM and the following was noted: The facility has outdoor furniture with a covered shaded area for residents and visitors. The garage is currently being used for laundry and storage. The facility has a swimming pool in the backyard with appropriate fencing and locking mechanism. The facility has a total of six (06) bedrooms and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory of which one (01) may be bedridden and a hospice waiver for two (02). The facility is currently occupying six (06) non-ambulatory residents. The living and dining room are neat and clean. The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. (CONT on LIC809-C) The bathroom was checked for cleanliness and proper operations. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The facility maintains a comfortable temperature at 72°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the dining area, observed to be full and last purchased 07/23/2025. Laundry detergents, cleaning agents and other toxins are locked away. The hot water temperature was measured at 117.1°F. LPA observed medication and first aid kit to be locked and inaccessible to residents. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Feb 11, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with Maxie Hamilton for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 01:30 PM and the following was noted: There is one entrance being utilized at the facility. The facility has a total of six (06) bedrooms and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory. The facility is currently occupying four (04) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility has a swimming pool with appropriate locked fencing. The garage is currently being used for storage and office. Laundry is located near the kitchen area. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 76°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the kitchen and fully charged. (continued on LIC 809-C) The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 113.8°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication and first aid kit to be locked and inaccessible to residents. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Feb 28, 2025

Allegation investigated: Medications were not secured making them accessible to residents in care. Chemicals were not locked up and were accessible to residents in care. Knives were not locked up and accessible to residents in care. Staff do not ensure solid waste was stored/disposed of appropriately.

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with Administrator, Maxie Hamilton, and explained the reason for the visit. ---Medications were not secured making them accessible to residents in care. ---Chemicals were not locked up and were accessible to residents in care. ---Knives were not locked up and accessible to residents in care. It was alleged that medication drawer, cleansers in the laundry room, and a knife were unlocked and accessible to residents. To investigate the allegation, LPA conducted a physical plant tour at around 11:00a.m. and interviewed one (01) staff at around 11:30a.m. (CONT. on LIC9099-C) Substantiated During the physical plant tour, LPA observed medications, sharps and chemicals unlocked, however, at the time staff were cooking, doing laundry and giving residents medications. During the interview, staff stated they are aware medications, chemicals and sharps were found unlocked during a visit by other parties and now keep everything locked when not in use. Based on interviews, there is enough information to verify the allegation, therefore, the allegation is SUBSTANTIATED at this time. ---Staff do not ensure solid waste was stored/disposed of appropriately. It was alleged that there are no lids on bathroom trash cans and living room trash can. To investigate the allegation, LPA conducted a physical plant tour at around 11:00a.m. and interviewed one (01) staff at around 11:30a.m. During the physical plant tour, LPA observed living room trash can with a lid, however, the bathroom trash did not have a lid. During the interview, staff stated they are aware of trash cans found without a lid during visit by other parties. Staff added they got a new one for the living room with a lid and the one in the bathroom will be taken out and replace with one that has a lid. Based on interviews and observations, there is enough information to verify the allegation, therefore, the allegation is SUBSTANTIATED at this time. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D): No other health and safety hazards noted during the visit. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 13, 2024 · control 31-AS-20241108103624

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87309(a) · Plan of correction due date: Nov 16, 2024

Storage Space: 87309 (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not as evidenced by; Based on information obtained from a credible source and interviews, facility did not ensure cleaning solutions, sharps, medications were inaccessible to residents which poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 13, 2024

Plan of correction: The Licensee will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to CCR Title 22 87309 Storage Space; The written letter must be sent to the LPA by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(2) · Plan of correction due date: Nov 16, 2024

Incidental Medical and Dental Care: 87465(h)(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not as evidenced by; Based on information obtained from a credible source and interviews, facility did not ensure medications were inaccessible to residents which poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 13, 2024

Plan of correction: The Licensee will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to CCR Title 22 87465 Incidental Medical and Dental Care; The written letter must be sent to the LPA by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(f)(3) · Plan of correction due date: Nov 16, 2024

Maintenance and Operation 87303(f)(3) All containers,….used for storage of solid wastes shall have tight-fitting covers… This requirement is not as evidenced by; Based on information obtained from a credible source, interviews and observations, facility did not ensure all containers used for solid waste storage have tight-fitting lids which poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 13, 2024

Plan of correction: The Licensee will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to CCR Title 22 87303 Maintenance and Operation; The written letter must be sent to the LPA by the POC due date.

Allegation investigated: Staff did not have resident's authorized representative sign an admissions agreement. Staff inappropriately recorded resident.

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with House Manager, Maxie Hamilton, and explained the reason for the visit. --- Staff did not have resident's authorized representative sign an admissions agreement It was alleged that responsible party never filled out any paperwork or given an Admissions Agreement. To investigate the allegation, on 10/09/2023 LPA interviewed two (02) staff between 12:30 PM to 01:30 PM. During interviews with staff, S1 stated that Resident #1 (R1) was in the facility for less than 24 hours. R1 was brought in on 09/05/2023 at around 08:00 PM as they were in desperate need to find placement. S1 added R1’s responsible party arrived shortly after and refused to sign any documents. (CONT. on LIC9099-C) Unsubstantiated S1 also stated R1 refused medications and the responsible party came the following morning, called an ambulance at around 09:00 AM and never returned. During interview with other parties, they stated facility never provided the Admissions Agreement or any other paperwork. Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. --- Staff inappropriately recorded resident It was alleged that staff recorded Resident #1 (R1). To investigate the allegation, on 10/09/2023 LPA conducted a physical plant tour at around 10:00 AM and interviewed two (02) staff between 11:30 AM to 12:30 PM and interviewed three (03) residents from 1:30 PM to 2:30 PM. During the physical plant tour, LPA did not observe any cameras or recording devices in the facility. During interviews with staff, all staff stated they do not record residents. During interviews with residents, all residents stated that they are aware of ever being recorded in the facility. During interviews with other parties, they stated they were shown videos of the R1 sleeping on the couch. Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Mar 15, 2024 · control 31-AS-20231003094310

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with house manager Maxie Hamilton for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at 08:30 AM and the following was noted: There is one entrance being utilized at the facility. The facility has a total of six (06) bedrooms and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory. The facility is currently occupying six (06) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility has a swimming pool with appropriate locked fencing. The garage is currently being used for storage and office. Laundry is located near the kitchen area. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 72°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the kitchen, fully charged and last purchased 09/06/2023. (continued on LIC 809-C) The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 116.1°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication and first aid kit to be locked and inaccessible to residents. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Feb 17, 2024

Allegation investigated: Facility pool is in disrepair Facility pool is accessible to residents

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with House Manager, Maxie Hamilton, and explained the reason for the visit. --- Facility pool is in disrepair It was alleged that the facility pool is filled with black water and residents would not be seen if they fell in. To investigate the allegation, on 10/09/2023 LPA conducted physical plant tour at around 11:00 AM, interviewed two (02) staff between 12:30 PM to 01:30 PM and interviewed three (03) residents from 1:30 PM to 2:30 PM. During the physical plant tour, LPA observed that water was clear and could see all the way to pool floor. During interviews with staff, all staff stated that the pool is cleaned every Wednesday and they have never observed black pool water. (LIC 9099-C) Unsubstantiated During interviews with residents, all residents stated that they are not aware of how often the pool is clean, have never used the swimming pool and that they have never witnessed the swimming pool to be black in color. Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. --- Facility pool is accessible to residents It was alleged that there is no fence around the facility pool. To investigate the allegation, on 10/09/2023 LPA conducted a physical plant tour at around 10:00 AM and interviewed two (02) staff between 11:30 AM to 12:30 PM. During the physical plant tour, LPA observed that the swimming pool had a locked fence that meets height regulations rendering the pool inaccessible to residents. During interviews with staff, all staff stated that the pool has always had a fence around it and is always locked. Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.the state’s words, verbatim · CDSS document, Oct 9, 2023 · control 31-AS-20231003094310

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.