Evco Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Administrator (ADM) Michelle Bayquen. LPA stated the purpose of the visit. ADM states the facility has 2 residents. LPA observed 1 resident and 1 staff. LPA toured the interior and exterior of the facility with ADM to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the kitchen cabinets and drawers to have dark areas around the handles, and spider webs hanging from light fixtures and overhead cabinets. LPA observed the chemicals and knives storage areas were not locked and accessible to residents. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by ADM. Fire extinguishers were last serviced on 8/13/2025. ADM stated she did not have documentation of fire drills. LPA inspected 2 resident bathrooms. LPA observed the bathrooms did not have hand-soap and paper towels. LPA advised ADM to ensure resident bathrooms have hand-soap and paper towels. LPA observed dark stains in the resident showers, and brown staining on the sinks and around the toilets. LPA also observed cobwebs throughout the bathroom ceilings. Page 1 of 2 LPA toured 2 resident rooms. LPA observed Resident Room #1 to have papers, clothing, beddings, and medications on the ground. LPA also observed a catheter bag with unknown liquid in an uncovered trash bin. Based on review of R1's physician's report, R1 cannot administer his/her own medications. In Resident Room #2 LPA observed 2 measuring cups on a dresser, with one cup containing brown liquid, and the other cup containing blue liquid with a dead inside inside. Staff S1 stated he/she did not know what the liquids were in the cups. ADM removed the cups with unknown liquids during inspection. Throughout the facility, LPA observed dark staining on the walls, cabinets, flooring of all rooms, bathrooms, kitchen and doorways. LPA advised ADM to ensure staff are cleaning to maintain sanitary conditions for residents, visitors and staff. LPA reviewed 2 resident records. LPA reviewed 2 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPA reviewed 3 staff records. 2 Out of 3 staff were associated and fingerprint cleared to the facility. Staff S1 is not associated to the facility. LPA reviewed S1's name in Guardian and S1 is not fingerprint cleared. S1 stated he/she has not done his/her fingerprints (LiveScan). LPA advised ADM to have S1 fingerprinted and associated to the facility, and S1 cannot work at the facility until he/she has obtained a background fingerprint clearance and is associated to the facility. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. A civil penalty is being assessed for the amount of $500 ($100 per day x 5 days = $500) for S1 working in the facility without receiving a criminal record background clearance. See LIC421BG. LPA also recommended ADM to Community Care Licensing Division's Technical Support Program (TSP). LPA provided ADM with a TSP pamphlet. Deficiencies were cited during today's visit per California Code of Regulations Title 22. An exit interview was conducted with Administrator Michelle Bayquen and a signed copy of this report and appeals rights were provided.the state’s words, verbatim · CDSS document, Nov 17, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced case management visit and met with licensee Thelma Blanchard. The purpose of today's visit is to follow up with the previous case management on 3/17/2025 and 3/27/2025. LPA observed 1 staff and 2 residents (R1 and R2) in the facility. LPA interviewed R1 and R2. R1 went to doctor appointment during LPA's visit. LPA observed a dish cleaning solution bottle on the sink in the kitchen, licensee removed it and locked it. LPA observed 4 resident rooms in the facility. 2 out of 4 resident rooms were observed not organized, Licensee stated staff clean resident room twice per week. Licensee stated the facility respects residents' privacy. Resident R1 stated he/she will clean up the room later. LPA discussed with licensee regarding to keep the facility in compliance including the documentation and reporting requirement. Exit interview was conducted with licensee. The report was provided to licensee for review and signature. A copy of the report was provided to licensee.the state’s words, verbatim · CDSS document, Apr 16, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Steve Chang Conducted an unannounced Plan of Correction visit to follow up the case management conducted on 3/17/2025, and met with Licensee (LCN) Thelma Blanchard. The facility was cited as Title 22 section 87464(f)(1) Basic services shall at a minimum include:(1) Care and supervision. On 3/12/2025, an altercation occurred between residents R1 and R2. R1 pushed R2 away and R1 was leaning on the chair. On 3/18/2025, the Department received a plan of correction from Administrator (ADM) Michelle Bayquen. LPA discussed with LCN regarding care and supervision to residents. LPA discussed with LCN regarding the updated appraisal needs and service plan. LPA discussed with LCN about the reporting requirement. LPA discussed with LCN regarding the staffing. LPA discussed with LCN regarding the resident behavior assessment and management. A deficiency was noted today that the Department did not receive incident report within 7 days for the incident occurred on 3/12/2025. Please see LIC809-D. Exit interview was conducted with LCN. The report was provided to LCN for review and signature. A copy of the report was provided to LCN.the state’s words, verbatim · CDSS document, Mar 27, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Apr 3, 2025

87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports ..., including, (1) A written report shall be submitted to the licensing agency ... within seven days of the occurrence ...(D)Any incident which threatens the welfare, safety or health of any resident ... The requirement was not met as evidenced by: Based on the records reviewed, the facility did not send the incident report of resident R1 and R2 within 7 days of the incident, this poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 27, 2025

Plan of correction: Licensee stated the facility to send plan of correction by the POC due date ensure the facility to send incident report in writing to CCL office within 7 days.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Steve Chang conducted a case management - incident visit and met with Licensee (LCN) Thelma Blanchard. On 3/12/2025, the Department received a notice that an altercation occurred between 2 resident (R1, R2). LPA toured the facility with LCN. LPA interviewed Licensee, 1 residents (R1). LCN stated on 3/12/2025, around 9:30AM, resident R1 sat at the dining table and R2 approached to the dining table. R1 and R2 had altercation. R1 pushed R2 away and R1 was leaning on the chair. LCN stated R2 did not fall down on the floor. LCN stated he/she talked to case manager around 11:30AM. R1 stated he/she does not remember what the date the incident occurred. R1 stated he/she pushed R2 away not hard. R1 stated after that he/she walked away from R2. Based on the interview, the facility staff lack of supervision leading to altercation between resident R1 and R2, and R1 pushed R2 away. Citation was issued today. See LIC809-D. Exit interview was conducted with LCN. The reports were provided to LCN for review and signature. Appeal Rights and a copy of the report were provided to LCN.the state’s words, verbatim · CDSS document, Mar 17, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Mar 18, 2025

87464 Basic Services(f) Basic services shall at a minimum include:(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interview, the facility did not provide the necessary care and supervision to resident R1 and R2 to meet their care needs and leading in that R2 pushed R1 which poses/posed an immediate Health, Safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 17, 2025

Plan of correction: Licensee agreed to send a plan of correction by the POC due date to ensure to provide the necessary care and supervision to ensure the similare incident not to happen again.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection, and met with licensee Thelma Blanchard (LCN) and Administrator (ADM) Michelle Bayquen. 1 staff and 3 residents were observed in the facility. License, personal right posters, ADM certificate were observed posted at the main entrance. ADM certificate was observed expired. ADM stated he/she renewed it. LPA checked online on the website, Administrator's ADM certificate is in active list. ADM stated the facility is a RCFE with MI residents. 2 resident file and 2 staff files were reviewed. LPA toured the facility inside out with ADM. Dinning room, kitchen and family room were inspected. 4 resident bedrooms and 2 restrooms were inspected. 1 office and 1 staff room were observed in the facility. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet was observed locked. Knives closet, and dish cleaning product closet were observed unlocked. ADM fixed the issues before LPA finished the visit. First aid box was observed in the facility. Room temperature was at 70 degree F and hot water temperature was at 119 degree F. resident bedroom #1 and #4 were observed little and waste scattered on the floor. ADM stated the 2 residents did not like staff to clean their room when they were at the rooms. Fire extinguisher was serviced on 9/23/2024. The facility was equipped with smoke and carbon monoxide detectors. Carbon monoxide detector was tested and was working fine. Front yard and backyard were inspected. Some boxes were observed at side of the building to block the walkways. ADM immediately removed the boxes. A storage room was observed at the backyard. ADM stated the last the facility conducted the emergency and fire drill was 11/7/24. Citations were noted today. See LIC809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was provided to ADMthe state’s words, verbatim · CDSS document, Nov 19, 2024

Allegation investigated: Staff did not supervise residents during altercation.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation finding and met with licensee Thelma Blanchard (LS). On 03/29/2023, the Department received a complaint that the facility staff did not supervise residents during alteration. On 04/05/2023, the Department conducted an initial investigation visit. LPA interviewed interviewed 1 staff and 3 residents. LPA requested resident's physician report and appraisal/needs and service plan. Continue on LIC9099-C. page 1 of 2. Unsubstantiated On 04/05/2023, LPA interviewed licensee Thelma Blanchard (LS). LS stated he/she was on site when the incident occurred. LS stated there was no alteration, no fighting, and no injury for the incident. LS stated residents R2 and R3 were standing and talking in the kitchen area while resident R1 was walking to refrigerator to get drinks, and R1 elbowed R2 out of the way. LS stated R2 did not react to R1. LS stated R2 did not get hurt and did not complain any pain. LS stated he/she reported the incident to R1's case manager by phone. LPA interviewed resident R1. R1 was unable to describe what happened for the incident. LPA interviewed resident R2. R2 stated he/she did not react to R1's behavior. R2 stated he/she did not get hurt and did not feel pain. LPA interviewed resident R4 who stated he/she heard there was an incident around 2 weeks ago, but he/she was not in the facility and did not know the detail. LPA observed R2 had no injury, redness or bruise on R2's body. Based on the interviews, a staff was on site supervising the residents. There was no alteration or fighting among residents at that time of the incident. There is no evidence to indicate the facility staff did not supervise residents during the incident. Based on investigation, observations, and interviews conducted, the Department found that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. No citations noted at today’s complaint investigation visit. Exit interview was conducted with LS. This report was provided to LS.the state’s words, verbatim · CDSS document, Jul 3, 2024 · control 26-AS-20230329163448

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection, and met with licensee Thelma Blanchard (LCN) and Administrator (ADM) Michelle Bayquen. 2 staff and 2 residents were observed in the facility. LCN stated the facility is a RCFE with MI residents. 2 resident file and 3 staff files were reviewed. LPA toured the facility inside out with ADM. Dinning room, kitchen and family room were inspected. 4 resident bedrooms and 2 restrooms were inspected. 1 office and 1 staff room were observed in the facility. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet was observed locked. Knives closet, and dish cleaning product closet were observed unlocked. One resident bedroom's screen window was observed missing. Litters were observed on the floors of dining room, kitchen and resident bedrooms. No non-skid mat was observed in the bathrooms. First aid box was observed in the facility. Room temperature was at 70 degree F and hot water temperature was at 119 degree F. Flash lights were observed out of battery. No night light was observed in the hall way, ADM stated the light in the hallway was turned at night. Two residents confirmed the light of the hallway was turned on at night. Fire extinguisher was serviced on 10/30/2023. The facility was equipped with smoke and carbon monoxide detectors. Carbon monoxide detector was found out of battery. Front yard and backyard were inspected. Three matters were observed at side of the building to block the walkways. LCN stated the last the facility conducted the emergency and fire drill was 4/16/24. Citations were noted today. See LIC809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was provided to ADMthe state’s words, verbatim · CDSS document, May 10, 2024

The state marks this report as 9 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.