Evergreen Residence

Type of visit: Case Management - Deficiencies

On 9/04/2023, Licensing Program Analyst (LPA) K.Kaur arrived unannounced to conduct a case management regarding Fire Prevention Inspection Report that was received from Visalia Fire Department. LPA met with Licensee Melanie Tantingco and introduced self and explained the reason for the visit. Based on the Visalia Fire Department Inspection the facility failed to ensure Fire Exits were free from obstructions. Fire Exits were Improperly locked with hardware that required a code and or key to allow exit. Deficiencies are being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. Immediate civil penalty assessed in the amount of $500. Exit interview was conducted with Licensee Melanie Tantingco, including discussing the plan of corrections. A copy of this report and appeal rights were discussed and provided to Administrator, whose signature on this form confirms receipt of this documentthe state’s words, verbatim · CDSS document, Sep 4, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Sep 4, 2026

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement is not met as evidenced by: Based on observation Exit door was blocked in the AL dining room with a table, plant and popcorn maker. Fire exit from Memory Care dining room into courtyard required a code. Both Backyard gates had padlocks that required a code for exit.the state’s words, verbatim · CDSS document, Sep 4, 2026

Plan of correction: Based on interview with Licensee and observation all fire exits were cleared of obstructions and locks removed. ***POC was provided during inspection***

Allegation investigated: Staff did not meet a resident's incontinence need

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on allegations listed. LPA met with Administrator Esmeralda Corona, and explained the purpose of today's visit. Regarding the allegation Staff did not meet a resident's incontinence need. LPA was not able to interview resident 1 as they are no longer a resident at this facility. LPA interviewed 3 facility staff who all stated Resident 1 would attempt to physically attack them if they attempted to assist with incontinent care. Staff stated they would not leave Resident 1 in a soiled brief but providing the assistance was challenging. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Nothe state’s words, verbatim · CDSS document, Dec 17, 2025 · control 24-AS-20251209104409

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to conduct a Case Management visit. LPA met with , and explained the purpose of today's visit. LPA interviewed multiple facility staff on 12/15/2025 that Resident 1’s arms were held down to prevent Resident 1 from being combative with staff while being provided incontinent care. Resident 1's current appraisal does not mention behaviors described by facility caregivers. Technical Violation on Personal Rights of facility residents reviewed, and updating assessment. Exit interview conducted with Administrator Esmeralda Corona, and copy of report providedthe state’s words, verbatim · CDSS document, Dec 17, 2025

Allegation investigated: Staff hit a resident

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to investigate the allegations listed above. LPA met with facility Administrator, Esmeralda Coronado, and explained the purpose of today's visit. Regarding the allegation Staff hit a resident. Based on interviews and documents reviewed Resident 1 has been having aggressive behaviors recently including being argumentative with staff and other residents. On 09/09/2025 Resident 1 was involved in an altercation with Resident 2. Resident 2 hit Resident 1 on the head during this altercation. Resident 1 was not hit by facility staff. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Nothe state’s words, verbatim · CDSS document, Sep 16, 2025 · control 24-AS-20250910101222

Type of visit: Required - 1 Year

On 8/26/2025, Licensing Program Analyst (LPA) J. Leffall arrived unannounced at the above facility to conduct a Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by staff. LPA met with Administrator (A1) Esmeralda Coronado LPA conducted facility tour with A1. All pathways, entrances and exits were clear from obstruction. LPA observed facility common areas which were furnished with sufficient seating. The tour continued to the facility dining room and facility kitchen. The kitchen was observed clean, in good repair with necessary items and appliances. LPA observed 7-day nonperishable and 2-day perishable foods. LPA toured several resident rooms which were observed to be furnished with required furniture and adequate lighting. Fire extinguishers observed throughout the facility with service date of October 3, 2024. Bathrooms were properly equipped with non-slip mats and grab bars. Residents observed in theater room watching television. Carbon monoxide detector tested and operational in hallways. No record of fire drill found on file for review. Memory care dining area toured. LPA observed delayed egress doors. Facility observed with a signal system. LPA toured an enclosed patio area with sufficient seating and shade for recreational purposes. Resident's records reviewed to have 1 missing document. Staff files were reviewed for good health. It was verified that there are at least two staff on duty who are CPR certified. Staff files reviewed to have 1 missing document. Continued to 809-C Samples of resident’s medications were observed locked in Med-Tech room. Clients’ MARS was reviewed with samples of resident’s medications. Deficiencies are being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. LPA is requesting the following documents be submitted to the Fresno CCL office by 9/9/2025: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020. An exit interview was conducted with Administrator. Report signed on-site; a copy of this report, 809D with appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 26, 2025

Type of visit: Required - 1 Year

On 10/08/2024, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct a Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by staff. LPA met with Administrator Esmeralda Coronado LPA conducted facility tour with Administrator. All pathways, entrances and exits were clear from obstruction. LPA observed facility common areas which were furnished with sufficient seating. The tour continued to the facility dining room and facility kitchen. At 11:14 AM LPA observed unlocked medication pills without a label, Eye drops and Hydrogen Peroxide in a cabinet in the dining area. The kitchen was observed clean, in good repair with necessary items and appliances. LPA observed 7-day nonperishable and 2-day perishable foods. At 11:18 AM LPA observed the Ice Machine to have Black mold underneath the door lift area and observed the inside of the lid was cracked. LPA toured several resident rooms which were observed to be furnished with required furniture and adequate lighting. Fire extinguishers observed throughout the facility with service date of October 3, 2024. Bathrooms were properly equipped with non-slip mats and grab bars. Residents observed in dining room playing Bingo. Carbon monoxide detector tested and operational in hallways. Memory care dining area toured. LPA observed delayed egress doors. Facility observed with a signal system. LPA toured an enclosed patio area with sufficient seating and shade for recreational purposes. Resident's records contained signed Admission Agreement, Personal Rights, and current Physician's Report. Staff files were reviewed for good health. It was verified that there are at least two staff on duty who are CPR certified. Staff files were reviewed for good health. It was verified that current staff on duty is CPR certified. At 1:05 PM LPA observed 3 residents with dementia diagnosis had medical assessment that were a year old. Continued to 809-C During Medication Audit LPA observed R’s medication was not logged in Centrally Stored Medication and Destruction Record (CSMDR). During Pill count it was observed pill bottle had extra 8 pills, Staff informed LPA medication was transferred from one bottle to the other so that is why the count is off. Deficiencies are being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. LPA is requesting the following documents be submitted to the Fresno CCL office by 10/15/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020. An exit interview was conducted with Administrator. Civil Penalty assessed for repeat violation. Report signed on-site; a copy of this report, 809D with appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 8, 2024

The state marks this report as 8 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Questionable death Resident sustained severe injuries due to staff neglect Staff are not checking on residents in a timely manner Staff did not call emergency services in a timely manner

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit to deliver findings. LPA met with Administrator Esmeralda Coronado and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. Based on interviews conducted and records reviewed the resident (R1) had a fall and was found by facility staff. Staff noticed residents breathing was shallow and contacted 911 and resident was taken to the hospital. Based on observation and interview of staff and residents, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore these allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 16, 2024 · control 24-AS-20230825144955

Allegation investigated: Facility did not ensure that resident's call light was operable. Facility did not place resident's call light within resident's reach. Facility did not administer medication as instructed by hospice. Facility did not safeguard resident's medication.

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit to deliver findings. LPA met with Administrator Esmeralda Coronado and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. Based on observations the resident’s (R1) call light was operable. Based on observations R1’s bedroom had a call button next to his bed. Based on interviews with staff resident also wore a lanyard with a call button. Facility administrated medication as per doctors orders unless medication was refused by resident. Based on observation and interview of staff and residents, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore these allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 16, 2024 · control 24-AS-20231030120725

Type of visit: Case Management - Annual Continuation

On 1/11/2024, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct a Continuation Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by staff. LPA met with Administrator Esmeralda Coronado LPA conducted facility tour with Administrator. All pathways, entrances and exits were clear from obstruction. At 10:45 AM LPA observed during first annual visit laundry room door was propped open by a hanger and disinfectants, bleach and laundry soap was accessible to residents. Based on staff interview laundry room door was propped open because the door gets jammed/stuck. LPA observed facility common areas which were furnished with sufficient seating. LPA toured several resident rooms which were observed to be furnished with required furniture and adequate lighting. Fire extinguishers observed throughout the facility with service date of October 16, 2023. Bathrooms were properly equipped with non-slip mats and grab bars. Residents observed with several care givers in commons areas playing music and exercising. LPA observed delayed egress doors. Facility observed with a signal system. LPA toured an enclosed patio area with sufficient seating and shade for recreational purposes. Carbon monoxide detector tested and operational in hallways. Memory care dining area toured. At 11:33 AM Memory care shower observed with broken/chipped tile and black like substance in the areas. Several rooms toured. At 12:10 PM LPA tested hot water temperature between 104 and degrees F and 131 degrees in several resident bathrooms. The tour continued to the facility dining room and facility kitchen. The kitchen was observed clean, in good repair with necessary items and appliances. LPA observed sufficient non-perishable and perishable foods. At 1:29 PM LPA observed the Ice Machine to have brown buildup underneath the door lift area. Continued to next page... Resident's records contained signed Admission Agreement, Personal Rights, and current Physician's Report. Staff files were reviewed for good health. It was verified that there are at least two staff on duty who are CPR certified. Staff files were reviewed for good health. It was verified that current staff on duty is CPR certified. Deficiencies are being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. LPA is requesting the following documents be submitted to the Fresno CCL office by 1/18/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020. An exit interview was conducted with Administrator. Civil Penalty assessed for repeat violation. Report signed on-site; a copy of this report, 809D with appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 11, 2024

Type of visit: Required - 1 Year

On 11/08/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by staff. LPA met with Administrator Esmeralda Coronado. LPA conducted a tour of the facility with Administrator. Due to time constraints, LPA will return at a later date for an annual continuation. LPA is requesting the following documents be submitted to the Fresno CCL office by 11/15/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan (LIC 610E), Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020. An exit interview was conducted with Administrator. Report signed on-site; a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 8, 2023