Eternity Care Home

Type of visit: Required - 1 Year

Licensee Program Analyst Jason Lund arrived unannounced to conduct an one year required inspection. LPA Lund met with care staff Hannah Bugas and explained the reason for the visit staff called Administrator Maria Payla who could not make the visit today. Administrator Maria Payla gave permission for care staff Hannah Bugas to sign the required paperwork. Census 3 LPA Lund & care staff Hannah Bugas toured/inspected the facility including common areas, resident bathrooms, kitchen, dining room, laundry, storage, and outside yard area. The facility is clean and in good repair and no odors were detected in areas toured. No hazards were noted in courtyard areas, hallways, doorways, etc. No equipment was stored in public areas. Fixtures and furniture all appear to be in good condition. Cleaning solutions are stored in the closet. Handrails are present in all shower and toilet areas, are secured. Room temperature was comfortable in facility. Facility has supply of bedding and towels. Furniture is appropriate in bedrooms for residents. There is adequate closet/drawer space available. There are plenty of bathrooms for number of residents. Non-skid mats will be purchased for the two showers. Kitchen is clean, well-supplied with equipment. Cooler/freezer appear to be at appropriate temperatures. First aid supplies available in several locations. Laundry equipment present, working telephone, emergency lighting. Medication was locked and secure. LPA Lund observed the fire extinguisher (08/11/2025) and carbon monoxide detector to be in compliance. LPA Lund reviewed two staff & two resident files and are in compliance. No deficiencies were observed at this time. Exit interview conducted and report left.the state’s words, verbatim · CDSS document, Sep 18, 2025

Allegation investigated: Licensee does not ensure facility staff is adequately staffed to meet residents needs resulting in unwitnessed falls Facility staff are not meeting residents toileting needs Facility staff left resident in urine soaked clothing for an extended period of time Facility staff did not seek timely medical attention for resident

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegations. LPA Lund met with Care staff Antonio Bugas and who called Administrator Maria Payla and explained the reason for the visit. Administrator Maria Payla gave permission to Care staff Antonio Bugas sign required paperwork. Census: 3 Licensee does not ensure facility staff is adequately staffed to meet residents needs resulting in unwitnessed falls- LPA Lund reviewed facility records, interviewed staff, reporting party, and residents in care. Based on records reviewed, interviews with staff, reporting party, and residents in care. Resident (R1) moved into the facility on 7/11/2024 and moved out on 10/15/2024. LPA Lund reviewed case notes for R1 which stated R1 had two falls during R1 stay at the facility. Care notes reviewed indicate that R1 fell on 10/7/24 and it was addressed by staff. Staff (S1) stated R1 refused emergency help, and first aid was applied. 10/15/2024 R1 fell and refused emergency help. That same morning R1 son came, and paramedics were called. LPA Lund reviewed facility staffing schedule’s from 7/1/2024 through 10/31/2024 revealed two staff on duty consistently residents in care. Unsubstantiated Based on records reviewed, interviews with staff, reporting party, and residents in care, on the information provided, it was unclear if licensee does not ensure facility staff is adequately staffed to meet residents needs resulting in unwitnessed falls, therefore the allegation was deemed UNSUBSTANTIATED. Facility staff are not meeting residents toileting needs- LPA Lund reviewed facility records, interviewed staff, reporting party, and residents in care. Based on records reviewed, interviews with staff, reporting party, and residents in care. Resident (R1) had monthly bowl movement records from 7/11/2024 through 10/15/2024. The reports stated when R1 had a bowl movement facility would change R1 depends. Staff interviewed stated that R1 would get their attention when needed to use the restroom. LPA Lund reviewed facility staffing schedule’s from 7/1/2024 through 10/31/2024 revealed two staff on duty consistently residents in care that include staff for the night. LPA Lund reviewed Samaritan Home Health report. R1 was a patient in-home starting on 8/16/2024 through 10/10/2024. R1 had a bowl movement and stated to Samaritan Home staff facility caregivers would change undergarment (Depends) per R1 routine with facility caregivers. Based on records reviewed, interviews with staff, reporting party, and residents in care, on the information provided, it was unclear if facility staff are not meeting residents toileting needs, therefore the allegation was deemed UNSUBSTANTIATED Facility staff left resident in urine soaked clothing for an extended period of time- LPA Lund reviewed facility records, interviewed staff, reporting party, and residents in care. Based on records reviewed, interviews with staff, reporting party, and residents in care. Staff interviewed stated that R1 would get their attention when needed to use the restroom. LPA Lund reviewed facility staffing schedule’s from 7/1/2024 through 10/31/2024 revealed two staff on duty consistently residents in care that include staff for the night. LPA Lund reviewed Samaritan Home Health report. R1 was a patient in-home starting on 8/16/2024 through 10/10/2024. R1 had a bowl movement and stated to Samaritan Home staff facility caregivers would change undergarment (Depends) per R1 routine with facility caregivers. Based on records reviewed, interviews with staff, reporting party, and residents in care, on the information provided, it was unclear if facility staff left resident in urine soaked clothing for an extended period of time, therefore the allegation was deemed UNSUBSTANTIATED. Facility staff did not seek timely medical attention for resident- LPA Lund reviewed facility records, interviewed staff, reporting party, and residents in care. Based on records reviewed, interviews with staff, reporting party, and residents in care. Resident (R1) moved into the facility on 7/11/2024 and moved out on 10/15/2024. LPA Lund reviewed case notes for R1 which stated R1 had two falls during R1 stay at the facility. Care notes reviewed indicate that R1 fell 10/7/24 and it was addressed by staff. Staff (S1) stated R1 refused emergency help, and first aid was applied. 10/15/2024 R1 fell and refused emergency help. That same morning R1 son came, and paramedics were called. LPA Lund reviewed Samaritan Home Health report which states R1 had many medical conditions including chronic kidney disease, congestive heart failure and type 2 diabetes. Based on records reviewed, interviews with staff, reporting party, and residents in care, on the information provided, it was unclear if facility staff did not seek timely medical attention for resident, therefore the allegation was deemed UNSUBSTANTIATED. As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and report left.the state’s words, verbatim · CDSS document, Apr 7, 2025 · control 27-AS-20241115093203

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to do a case management visit. LPA Lund met with Care staff Antonio Bugas and who called Administrator Maria Payla and explained the reason for the visit. Administrator Maria Payla gave permission to Care staff Antonio Bugas sign required paperwork. Census: 3 LPA Lund was investigating a complaint investigation regarding resident (R1). It was reported to licensing that R1 had multiple falls. On 10/15/2024 the staff informed the family that R1 had a fall and was transported to the Emergency Room (ER). The facility didn’t report the falls (Injuries) to licensing as well R1 going to the hospital. The facility failed to fill out an Unusual Incident/Injury Report (LIC624) for R1’s fall on 10/15/2024. Per California Code of Regulations, Title 22, the following deficiencies, and immediate civil penalty have been issued for repeat violation. Exit interview conducted and report provided. Appeals rights printed.the state’s words, verbatim · CDSS document, Apr 7, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(B) · Plan of correction due date: Apr 21, 2025

written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below….. This requirement was not met as evidenced by: Community Care Licensing didn’t receive UIR for the incident on 10/15/2024. This poses a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 7, 2025

Plan of correction: Administrator Maria Payla will have training with Staff regarding the deficiency and email LPA Lund the POC.

Type of visit: Required - 1 Year

Licensee Program Analyst Jason Lund arrived unannounced to conduct an annual/required inspection. LPA Lund met Administrator Maria Payla and explained the reason for the visit. Census 5. LPA inspected the facility including common areas, resident bathrooms, kitchen, dining room, laundry, storage, and outside yard area. The facility is clean and in good repair and no odors were detected in areas toured. No hazards were noted in courtyard areas, hallways, doorways, etc. No equipment was stored in public areas. Fixtures and furniture all appear to be in good condition. Cleaning solutions are stored separate from food. Handrails are present in all shower and toilet areas, are secured. Room temperature was comfortable in facility. There are no bodies of water on the premises. Facility has supply of bedding and towels. Furniture is appropriate in bedrooms for residents. There is adequate closet/drawer space available. There are plenty of bathrooms for number of residents. Non-skid mats will be purchased for the two showers. Emergency lighting available. Kitchen appears to be clean, well-supplied with equipment. Cooler/freezer appear to be at appropriate temperatures. First aid supplies available in several locations. Laundry equipment present, working telephone, emergency lighting. Medication was locked and secure. LPA Lund observed the fire extinguisher (08/21/2024) and carbon monoxide detector to be in compliance. LPA Lund reviewed two staff & two resident files. No deficiencies were observed at this time. Exit interview conducted and report left.the state’s words, verbatim · CDSS document, Sep 5, 2024