Emmaus Care I

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to conduct a Case Management - Legal/Non-compliance visit. LPA introduced herself and was granted entry into the facility by Staff, Julieta Espino. Licensee, Janette Monillas arrived during the visit. During today's visit, LPA toured the facility and observed residents in care. Health or safety issues were observed but cited on the annual required visit [See LIC 809, Required Annual Inspection, dated 09/15/26]. The licensee was knowledgeable with the following topics: 87628 Diabetes; 87457 Pre-Admission Appraisal; 87612 Restricted Health Conditions; 87632 Hospice Care Waiver. LPA also covered 87615 Prohibited Health Conditions. No deficiencies were issued. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee, Janette Monillas whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Sep 15, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility by Staff, Julieta Espino. Licensee, Janette Monillas arrived during the visit. LPA, accompanied by the licensee, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. However, there were unwanted items items being stored. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. However, the appropriate bedding was not present on residents beds. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. However, there were no N95's present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Hot water temperature at taps accessible to residents were all compliant and measured at 115 F.. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were toxic chemicals/poisons, and medications accessible to residents. The staff room was open, inside were medications and items that could pose a danger. In addition, there was a large amount of paint cans located in the backyard accessible to residents. Both were made inaccessible to residents during the visit. Medications were labeled, as required, and stored in locked areas. However, another resident's medications were stored with another resident's medications. Some medications did not have orders, and there were prescribed PRN medications that were expired. Also, there was an order on file for a PRN but the PRN medication was not available for the resident, and PRN medications were not being documented. Continued on LIC 809C. No pools or bodies of water were observed on the premises. Per the licensee, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. First aid kit was complete and readily accessible. However, the First Aid manual was not present. Required licensing postings were observed in visible areas of the facility. LPA reviewed multiple staff and resident records/files. The reviewed files did not contain required documents. Confidential records were stored in locked areas. Deficiencies were observed or cited during today's annual inspection. Advisory notes were also issued. An exit interview was conducted with Licensee, Janette Monillas to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Sep 15, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Sep 16, 2026

Storage Space and Access. Except ... the licensee shall ensure ...cleaning solutions, poisonous substances... and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observations, the licensee did not ensure items that could pose a danger were inaccessible to 4 out of 5 residents [R1-R4], which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 15, 2026

Plan of correction: Licensee removed the immediate threat and stored all items that pose a danger and staff room was also locked and made inaccessible during the visit, POC corrected.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(4) · Plan of correction due date: Oct 13, 2026

Incidental Medical and Dental Care. All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not ensure all prescribed medications were present and expired medications disposed of for 2 out of 5 residents [R1;R5], which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 15, 2026

Plan of correction: Licensee stated they will ensure all prescribed medications are stored in the facility for resident use. Also, all expired medications will be documented on the CSMDR and destroyed by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(e) · Plan of correction due date: Oct 13, 2026

Incidental Medical and Dental Care. For every prescription and nonprescription PRN medication...shall be a signed, dated written order from a physician... maintained in the residents file ...medication. This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not ensure medication orders were on file for 2 out of 5 [R1;R5] residents which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 15, 2026

Plan of correction: Licensee agreed to obtain orders for all resident's medications by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(c)(3) · Plan of correction due date: Oct 13, 2026

Incidental Medical and Dental Care. If the resident's physician...provided all of the following requirements are met: A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not document PRN medications that were dispensed to 5 out 5 [R1-R5] residents, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 15, 2026

Plan of correction: Licensee stated a PRN log was available, however, staff were not documenting. In addition, licensee stated staff will begin using PRN log again and staff will attend vendor training on medications by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87615(a)(5) · Plan of correction due date: Oct 13, 2026

Prohibited Health Conditions. Residents who depend on others to perform all activities of daily living for them as set forth in Section 87459, Functional Capabilities. This requirement is not met as evidenced by: Based on record review and interviews, the licensee retained 1 out of 5 residents [R1] with a prohibited health condition, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 15, 2026

Plan of correction: Licensee stated they overlooked R1's physician's report regarding capacity for self care. Licensee stated they will submit an exception by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1565(c) · Plan of correction due date: Oct 13, 2026

A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter...scenarios. An actual evacuation...during a drill. While a facility...shall not require that participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and, if applicable, the names of staff participating in the drill. This requirement is not met as evidenced by: Based on record review and interviews, the licensee did not conduct a quarterly disaster drill for 8 out 8 staff, which poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Sep 15, 2026

Plan of correction: Licensee stated they will conduct a quarterly disaster drill with all staff in attendance and submit proof of training by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Oct 13, 2026

Resident Records. A separate, complete, and current record shall be maintained for each resident in the facility, readily available to facility staff and to licensing agency staff and shall contained specified information. This requirement is not met as evidenced by: Based on record review, the licensee did not ensure 1 out of 5 [R5] residents records had a current resident appraisal and physician's report on file, which poses a potential health and safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 15, 2026

Plan of correction: Licensee stated they will provide current resident records by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.625(b)(2) · Plan of correction due date: Oct 13, 2026

Staff training; legislative findings; contents. In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Based on records review, the licensee did not ensure 8 out of 8 staff had current training on file, which posed a potential health and safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 15, 2026

Plan of correction: Licensee stated they will provide proof of current annual staff training by POC due date.

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to conduct a Case Management - Legal/Non-compliance visit. LPA introduced herself and was granted entry into the facility by Staff, Lilia Ramos. LPA met with Staff, Julieta Espino. LPA spoke with Licensee, Janette Monillas via telephone while at the facility to discuss regulations. During today's visit, LPA toured the facility and observed residents in care. No health or safety issues were observed at this time and no citations were issued. The licensee was knowledgeable with the following topics: 87628 Diabetes; 87457 Pre-Admission Appraisal; 87612 Restricted Health Conditions; 87632 Hospice Care Waiver. No deficiencies were issued. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Staff, Julieta Espino whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Jul 31, 2026

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to conduct a Case Management - Legal/Non-compliance visit. LPA introduced herself and was granted entry into the facility by Staff, Elena Catacutan. LPA met with Licensee, Janette Monillas. During today's visit, LPA toured the facility, observed residents in care. No health & safety issues were observed at this time and no citations were issued. The licensee was knowledgeable with the following topics: 87628 Diabetes; 87457 Pre-Admission Appraisal; 87612 Restricted Health Conditions; 87632 Hospice Care Waiver. No deficiencies were issued. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee, Janette Monillas whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Apr 30, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced Case Management - Other visit. LPA was greeted and allowed entry into the facility and conducted the visit with Licensee, Janette Monillas. The purpose of the visit was to obtain a signature for a licensing document. No deficiencies were observed or cited during today's visit. An exit interview was conducted with Licensee, Janette Monillas to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Oct 8, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility and conducted the visit with Staff, Prospero Abar. Licensee, Janette Monillas arrived during the visit. LPA, accompanied by licensee, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Hot water temperature at taps accessible to residents were all compliant and measured at 113 F.. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, and/or fireplaces accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water were observed on the premises. Per the licensee, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed multiple staff and residents. LPA reviewed multiple staff and resident records/files. The reviewed files contain required documents. Confidential records were stored in locked areas. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Licensee, Janette Monillas to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit. LPA was absent from the facility from 2:00pm-3:00pm.the state’s words, verbatim · CDSS document, Sep 25, 2025

Allegation investigated: Questionable death Staff admitted a resident who required a higher level of care

Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude the complaint investigation regarding the above-mentioned allegations. LPA met with Licensee, Janette Monillas. During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged that staff admitted a resident who required a higher level of care, and a questionable death. The facility was managed by Bright Senior Management (BSM), LLC as of September 1, 2024. The licensee is a Registered Nurse (RN) and is the only staff member that is an appropriately skilled medical professional at the facility. No one with the management company, BSM, LLC is an appropriately skilled medical professional. The licensee was out of the country and returned on March 3, 2025. Due to the licensee being out of the country, BSM, LLC the management company, admitted R1 to the facility. Resident #1 (R1) was discharged from a Skilled Nursing Facility (SNF) on March 5, 2025, to the facility and assigned a Home Health agency. Continued on an LIC 9099C. Substantiated R1’s Physician’s Report dated February 28, 2025, indicated R1 had a secondary diagnosis of Diabetes Mellitus Type 2. It also stated R1 was unable to administer their own medications, including injections and own glucose testing. The management company did not complete a Preplacement Appraisal for R1. The licensee’s interview confirmed that they told the management company they were not present and if R1 required assistance with insulin, R1 would need to have someone do the insulin because the licensee was unavailable. The licensee also confirmed the caregivers are not allowed to do the insulin, as they are not skilled professionals. The licensee explained that the management company reported to the licensee that R1 was able to do their own insulin. The licensee made the management company aware, if R1 was not capable, the management company would need to hire a professional, or a family member. The licensee also stated they were told by the management company that R1 was alert and oriented, and R1 was able to manage their own insulin and capable of doing it. The Discharge Summary from the SNF included the following two (2) medications: Humalog Solution 100 Unit/ml (milliliter) (Insulin Lispro (Human) with instructions to inject per sliding scale subcutaneously with meals for diabetes; and Insulin Glargine Solution 100 Unit/ml, with instructions to inject 10 unit subcutaneously two times a day for diabetes. On March 6, 2025, the Home Health, Registered Nurse (RN) visited R1 at the facility. The RN reported that Staff #1 (S1) from BSM, LLC, Marketing were also present. The diabetic supplies on hand included two insulin pens, but there was no glucometer. The RN used their own glucometer to get blood sugar readings for R1, which measured at 190. The RN explained the home health staff are not providing 24-hour care, therefore, R1 themselves must be able to administer their own medication or receive assistance from the facility’s staff to take their medication. The RN explained to S1 that after taking the blood sugar reading, R1 needed to take their insulin, to which S1 acknowledged will be done, and placed the insulin in the refrigerator. On March 6, 2025, Staff #2 gave R1 their insulin pen, but did not observe R1 inject themselves. Continued on an LIC 9099C. On March 7, 2025, R1 reported to Staff #3 (S3) they were not feeling well and did not eat breakfast. R1 had a small amount of food for lunch and went back to sleep. At approximately between 3pm to 4pm, Staff #4 (S4) gave R1 their insulin pen, but S4 did not know the dosage the insulin pen was set at as there was no glucometer at the facility. S4 observed R1 inject insulin in their stomach. At approximately 6pm, R1 started to get restless. The Home Health agency was notified and instructed the facility to contact emergency services. R1 was transported to Hospital for evaluation. A review of the hospital records indicated the chief complaint was “Altered Mental Status.” The Emergency Department (ED) noted a Comprehensive Metabolic Panel: Glucose – 1264. The Mayo Clinic defines Hyperosmolar syndrome is caused by very high blood sugar that turns blood thick and syrupy. The Mayo Clinic also indicated blood sugar readings over 600 mg/dL are symptoms of a life-threatening condition. A review of the paramedic report documented upon arrival at the facility stated R1 was thrashing around their bed. The hospital’s Discharge Summary Report indicated drug-induced diabetes who presented to the emergency room March 7, 2025, with altered mentation and minimal responsiveness, found to have blood sugars in the 1200 range and diagnosed with hyperglycemic hyperosmic syndrome and diabetic ketoacidosis. R1 was admitted to the ICU (Intensive Care Unit), during which time they had an evolution of shock requiring three vasopressors, renal failure and respiratory failure. In setting maximum medical therapy with no improvement in clinical status and progressive multi organ dysfunction, R1 was transitioned to comfort focused measures for end-of-life care. R1 passed away at the hospital on 03/09/25. R1’s death certificate identified the cause of death as the following: Acute Encephalopathy; Hypovolemic Shock; Diabetes Mellitus Type I with Hyperosmolar Hyperglycemic State; and Small Cell Bladder Cancer. The medical records obtained were reviewed by the Department’s Program Clinical Consultant, Nurse Evaluator II. The nurse evaluator reported that not receiving insulin as prescribed is directly related to the development of Hyperosmolar Hyperglycemic State, which can then cause Acute Encephalopathy and Hypovolemic Shock. The nurse evaluator also reported these acute complications result from severe Hyperglycemia and dehydration that occurs when insulin is absent. The nurse evaluator explained if R1 received their insulin as prescribed while at the facility, it is possible R1 would still be alive. Continued on an LIC 9099C. Based on interviews conducted, and a review of pertinent records, corroborating evidence was obtained that staff neglect resulted in R1 ‘s death. Although staff reportedly gave R1 their insulin on March 6, 2025, only one facility staff member witnessed R1 injecting themselves with insulin while at the facility on March 7, 2025. In addition, interviews corroborate there was no glucometer for R1 to use at the facility. Without a glucometer, it is unknown how much insulin R1 actually needed during their time at the facility, and R1 was evaluated in the hospital with a glucose reading of 1264. In addition, R1 was admitted to the facility requiring a higher level of care due to the facility not having a present skilled professional to administer glucose testing and insulin injections. The preponderance of the evidence standard has been met, and the findings are substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8 are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee, Janette Monillas whose signature below confirms receipt of these rights. A Civil Penalty of $500 is being assessed for any violation that the department determines resulted in the injury or illness of a person in care. [See LIC 811 Confidential Names List to identify Resident #1]the state’s words, verbatim · CDSS document, Sep 10, 2025 · control 08-AS-20250320132935

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87628(a) · Plan of correction due date: Sep 11, 2025

Diabetes. The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood...or has it administered by an appropriately skilled professional. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not ensure a skilled professional was available to administer insulin injections for 1 out of 4 [R1] residents which posed an immediate health and safety to risk to residents in care.the state’s words, verbatim · CDSS document, Sep 10, 2025

Plan of correction: The Licensee ceased agreement with the management company. The licensee stated they will be overseeing the facility's daily activity. In addition, the licensee stated In-Service training on Diabetes will be conducted with staff. The licensee was advised to schedule the training by the POC due date and provide the scheduled date. In addition, the licensee will provide proof of training within 2 weeks. A civil penalty was assessed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87457(c) · Plan of correction due date: Sep 11, 2025

Pre-Admission Appraisal. Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs... Acceptance and Retention Limitations. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not complete a Preplacement Appraisal for 1 out of 4 [R1] residents which posed an immediate health and safety to risk to residents in care.the state’s words, verbatim · CDSS document, Sep 10, 2025

Plan of correction: The licensee stated the management company was in charge of placement, now the agreement with the management company has ceased. The licensee stated they will attend vendor training on Pre-admission appraisal. The licensee was advised to schedule the training by the POC due date and provide the scheduled date. In addition, the licensee will provide proof of training within 2 weeks.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management- Deficiencies visit. LPA was greeted and allowed entry into the facility by staff, Elena Catacutan. LPA met with Licensee, Janette Monillas. During a complaint investigation, it was discovered that the licensee hired a management company, Bright Senior Management (BSM), LLC on 09/01/24. The management company was present at times in the facility and responsible for new admissions. Two (2) of the employees at BSM, LLC did not have the required Criminal Record Clearance. Staff #1 (S1) has a Criminal Record Exemption on file but was never associated with this facility or received approval for the transfer of a criminal record exemption to this facility. Staff #2 does not have a fingerprint clearance or association with this facility. It was also discovered the licensee signed off approval on an Incident Report and Death Report for Resident #1 (R1) with inaccurate information. The incident Report dated 03/07/25 indicated R1 became restless due to claustrophobia and was provided with prescribed medication. The report also stated R1 was restless due to their roommate experiencing a medical emergency. The death report listed a medical condition as the cause of death, instead of true events. R1 had diabetes that required insulin injections. The facility was aware R1 required insulin injections, prior to admission. The facility’s staff are not skilled professionals, only the licensee is a medical professional. The facility’s documentation did not list the high blood sugar, which later resulted in death. The licensee approved false claims made on the reports. Deficiencies were cited on the attached LIC 809D and Civil Penalties were assessed on the LIC 421's. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee, Janette Monillas whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Sep 10, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(4) · Plan of correction due date: Sep 11, 2025

Criminal Record Clearance. All individuals subject to a criminal record review...prior to working, residing... Request and be approved for a transfer of a criminal record exemption...the Department permits the individual to be employed, reside or be present at the facility. This requirement is not met as evidenced by: Based on interviews and record review, the licensee allowed 1 out of 8 [S1] staff to work prior to receiving an approved exemption, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 10, 2025

Plan of correction: The licensee stated she now has access to Guardian and will ensure individuals are fingerprint cleared, associated, and any exemptions are transferred prior to allowing the staff to work or be present in the facility. The licensee stated she will attend vendor training on Criminal Record Clearance. The licensee will schedule the training by the POC due date and provide scheduled information. The licensee will submit proof of training within 2 weeks. A civil penalty was assessed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e)(2) · Plan of correction due date: Sep 11, 2025

Criminal Record Clearance. Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Based on interviews and record review, the licensee allowed 1 out of 8 [S2] staff to work prior to receiving an approved criminal record clearance, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 10, 2025

Plan of correction: The licensee stated she now has access to Guardian and will ensure individuals are fingerprinted cleared and associated prior to allowing the facility to work or be present in the facility. The licensee stated she will attend vendor training on Criminal Record Clearance. The licensee will schedule the training by the POC due date and provide scheduled information. The licensee will submit proof of training within 2 weeks. A civil penalty was assessed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87207 · Plan of correction due date: Sep 22, 2025

False Claims. No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not ensure reports were accurrate for 1 out of 4 [R1] residents, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 10, 2025

Plan of correction: The Licensee stated the information they provided were the facts provided to them by the management company. The licensee has ceased the agreement with the management company. The licensee stated she will attend training on Reporting Requirements and provide proof by POC due date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregivers Elena Catacutan and Julieta Espino. Administrator Janette Monillas arrived during the visit. During today’s visit, LPA conducted a health and safety check, observed residents in care, and reviewed facility records and centrally stored medications. Review of the centrally stored medications revealed that 2 of 5 residents had medications that were stored by the facility that were not logged in the facility's centrally stored medication log. Interviews with Administrator Monillas revealed that those medications most likely were brought in during resident intake. The following deficiency was cited for medication records and noted on the attached LIC809-D page. An exit interview was conducted with Administrator Janette Monillas, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Aug 18, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(6) · Plan of correction due date: Sep 18, 2025

87465 (h)(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year... This requirement has not been met as evidenced by: Based on interview and observation, the Licensee did not comply with the section cited above in that medication storage logs did not contain all stored medications for 2 of 5 residents. This poses a potential health risk of 5 of 6 residents.the state’s words, verbatim · CDSS document, Aug 18, 2025

Plan of correction: Administrator will provide proof of inservice training and will provide signed task checklist showing completed medication audit by POC due date of 9/18/2025. Administrator will be auditing centrally stored medication supply monthly and will be conducting inservice training for staff on accepting medications during intake. Staff will be instructed to notify the Administrator on duty of any new medications.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility and conducted the visit with Staff, Prospero Abar. Licensee, Janette Monillas arrived during the visit. LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Hot water temperature at taps accessible to residents were all compliant and measured at 114 F.. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, and/or fireplaces accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water were observed on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed multiple staff and residents. LPA reviewed multiple staff and resident records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Licensee, Janette Monillas to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Sep 27, 2024