Excelcare

Allegation investigated: Staff do not ensure a resident is being properly fed Staff do not ensure a resident consumed an appropriate amount of liquid Staff served a resident spoiled food Staff are not abiding to the admission agreement Staff do not timely address a resident's change in medical condition Staff do not meet a resident's bathing needs Staff do not provide a comfortable temperature for a resident

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to deliver findings on a complaint investigation regarding the above allegations. LPA met with Caregiver Rose Viernes and discussed the purpose of the visit. Regarding Allegation #1: During the lunch observation, LPA noted that the resident’s meal appeared to be of good quality. LPA also observed an adequate supply of perishable and non perishable food items for residents in care. LPA interviewed two (2) staff members, both of whom stated that residents are being properly fed. LPA additionally interviewed four (4) residents, all of whom confirmed they are properly fed. Regarding Allegation #2: LPA observed a cup of water in each resident’s bedroom. LPA interviewed two (2) staff members, both stating they ensure residents are drinking enough water. The Administrator also stated that water is always available in residents’ rooms. LPA interviewed five (5) residents, all of whom reported receiving an adequate amount of liquids. Unsubstantiated Regarding Allegation #3: LPA did not observe any spoiled food in the facility. LPA interviewed two (2) staff members, both of whom stated they do not serve spoiled food to residents. Administrator states some residents have refrigerators in their rooms, maybe some food items may have spoiled without their knowledge. LPA also interviewed four (4) residents, all of whom stated they are not served spoiled food. Regarding Allegation #4: LPA interviewed two (2) staff members, both stating they are adhering to the admission agreement. The administrator also stated that they are not responsible for determining rent increases and that all payment adjustments are handled directly through InnovAge. LPA interviewed three (3) residents; two (2) stated staff follow the admission agreement, while the remaining resident was unsure. Regarding Allegation #5: LPA interviewed two (2) staff members, both stating they address changes in a resident’s condition in a timely manner. The Administrator stated that if a resident’s condition worsens, responsible parties, families, and social workers are notified immediately. LPA interviewed three (3) residents; two (2) reported that staff respond to changes in their condition in a timely manner, while the third did not understand the question. Regarding Allegation #6: LPA interviewed two (2) staff members who both stated that residents’ bathing needs are being met, although residents occasionally refuse showers. LPA interviewed four (4) residents, all of whom stated their bathing needs are being met. Regarding Allegation #7: LPA observed the facility to be at a comfortable temperature, with the thermostat reading 70 degrees Fahrenheit. LPA interviewed two (2) staff members, both stating the facility is maintained at a comfortable temperature. LPA also interviewed five (5) residents, all of whom confirmed the temperature is comfortable. Based on LPAs observations, record review, and interviews, the above allegations are Unsubstantiated; meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted where this report was discussed and a copy was provided to Caregiver Rose Viernes at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jun 19, 2026 · control 56-AS-20251204115820

Allegation investigated: Staff neglect resulted in a resident sustaining pressure injuries while in care Staff did not ensure a resident consumed an appropriate amount of liquid while in care Resident sustained unexplained injuries while in care Staff allowed a resident to be soiled while in care

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to deliver findings on a complaint investigation regarding the above allegations. LPA met with Caregiver Rose Viernes and discussed the purpose of the visit. Regarding Allegation #1: It was alleged that Resident #1 (R1) developed a pressure injury while in care due to staff neglect. LPA was unable to interview R1, as they are no longer a resident of the facility. LPA interviewed two (2) staff members. One (1) staff member reported that, to their knowledge, R1 did not have any pressure injuries. The second staff member stated that R1 had a small stage 2 wound on the buttocks; however, they did not believe it was the result of neglect. The Administrator reported suspecting that R1 may have had cancer and stated the concern was communicated to InnovAge. Unsubstantiated Regarding Allegation #2: LPA observed a cup of water in each resident’s bedroom. LPA interviewed two staff members, both of whom stated they ensure residents remain adequately hydrated. The Administrator reported that water is always available in residents’ rooms. Both staff members also explained that although R1 consistently had water available, R1’s health was declining, and they were experiencing difficulty swallowing. This concern was communicated to InnovAge; however, no additional follow-up was reportedly conducted. LPA interviewed five (5) residents, all of whom reported receiving an adequate amount of liquids. Regarding Allegation #3: It was alleged that R1 sustained unexplained injuries while in care. LPA interviewed two (2) staff members, both of whom stated that R1 did not sustain any falls at the facility during the period in question. They reported being informed that R1 had slipped out of their wheelchair while at InnovAge. One (1) staff member observed bruising on R1’s buttocks, and R1 reported the injury occurred due to slipping at InnovAge. The Administrator stated that Resident #2 (R2) reported witnessing R1 slip out of their wheelchair at InnovAge; however, R2 was unable to be interviewed as they were out in the community. Regarding Allegation #4: LPA interviewed two (2) staff members, both of whom stated that R1 was never left soiled, nor are other residents left soiled while in care. LPA interviewed one (1) resident, who reported that staff do not leave them soiled and that when assistance is needed, staff respond promptly. Based on LPAs observations, record review, and interviews, the above allegations are Unsubstantiated; meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed and a copy was provided to Caregiver Rose Viernes at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jun 19, 2026 · control 56-AS-20250324114757

Allegation investigated: Resident was not accorded dignity in their relationship with a person in the home

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to deliver findings on a complaint investigation regarding the above allegation. LPA met with Administrator Dorris Anderson and discussed the purpose of the visit. Regarding the allegation that a resident was not accorded dignity in their relationship with a person in the home, interviews with the Administrator and resident revealed that the individual in question was a minor family member. In accordance with regulations, minors are not required to undergo fingerprinting or background clearance. The individual was not residing in the home during the investigation, and interviews indicate that during the period in which they did reside at the home, they were not disruptive to residents. Based on LPAs observations and interviews, the above allegation is Unsubstantiated; meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed and a copy was provided Administrator Dorris Anderson at the conclusion of the visit. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 21, 2026 · control 56-AS-20260210101558

Allegation investigated: Staff does not ensure facility is kept clean. Staff does not ensure resident's clothing are properly dried.

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Administrator Dorris Anderson, and discussed the purpose of the visit. Regarding allegation #1, LPA toured and observed the facility to be clean. LPA interviewed 5 residents, 4 of the 5 residents informed LPA, staff ensure the facility is kept clean. 1 of the 5 residents was unable to answer LPA’s question. LPA interviewed caregiver on duty and informed LPA the facility is always kept clean. Administrator states the facility is always kept clean and they clean morning and night. Regarding allegation #2, LPA interviewed 5 residents, 2 of the 5 residents were unable to answer the question. 3 of the 5 residents informed LPA staff properly dry, fold, and store their clothing; the same 3 residents informed LPA staff do not hang dry their clothes outside. Unsubstantiated LPA interviewed two (2) staff, both staff informed LPA they wash and ensure residents’ clothes are thoroughly dried. Staff informed LPA residents’ clothes are not hung outside, however residents who are bedridden their bed sheets are hosed down outside prior to being washed in the washer if dirty with stool. Based on LPA’s observations, staff and resident interviews, and relevant documentation, the allegations are determined to be Unsubstantiated. An Unsubstantiated finding means that although the allegations may be valid or could have occurred, there is insufficient evidence to support that the alleged violations did or did not happen. An exit interview was conducted with Caregiver Rose Viernes, and a copy of this report was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Dec 29, 2025 · control 56-AS-20251223092904

Allegation investigated: Staff are not providing residents food of good quality. Staff do not provide resident with a variety of food. Staff did not safeguard resident's personal belongings.

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to deliver findings on the allegations mentioned above. LPA met with Administrator Dorris Anderson and explained the purpose of the visit. Regarding allegation #1, LPA observed the resident’s meal during lunch and it appeared to be of good quality. LPA interviewed 5 residents, 4 of the 5 residents informed LPA the food being provided is of good quality. 1 of the 5 residents was unable to answer LPA’s question. LPA interviewed two (2) staff both informed LPA the residents are being provided with good quality food every day. Administrator informs LPA they follow the food plan from Loma Linda University to help maintain their good health. Unsubstantiated Regarding allegation #2, LPA observed the facility menu and toured the facility kitchen, LPA observed the facility to have different variety options for residents. LPA interviewed 5 residents, 2 of the 5 residents were unable to answer LPA’s question. 3 of the 5 residents informed LPA they are provided with variety options. LPA interviewed two (2) staff, both staff informed LPA the residents are provided with a variety of food options. Administrator explains to LPA the residents are accommodated and the menu is changed upon request. Regarding allegation #3, LPA interviewed 5 residents. 2 residents were unable to answer LPA’s question. 3 of the 5 residents informed LPA their belongings are kept safe in their rooms. LPA interviewed caregiver on duty and informed LPA no residents’ belongings have been stolen at the facility. Administrator explains to LPA it is alleged resident #6 (R6) had stolen an item from resident #7 (R7)'s room, however it was retrieved, given back to the resident, and R7 was given a key to lock their room to ensure no other items would be stolen. Based on LPA’s observations, staff and resident interviews, and relevant documentation, the allegations are determined to be Unsubstantiated. An Unsubstantiated finding means that although the allegations may be valid or could have occurred, there is insufficient evidence to support that the alleged violations did or did not happen. An exit interview was conducted with Caregiver Rose Viernes, and a copy of this report was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Dec 29, 2025 · control 56-AS-20251208093045

Allegation investigated: Staff do not follow physicians orders

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPA met with Administrator Dorris Anderson, and discussed the purpose of the visit. It is alleged staff are not following physician’s orders, based on record review, interviews with residents staff and Licensee. LPA did not find any discrepancies to corroborate the allegation. LPA was unable to interview R1 due to no longer residing at the facility, R1 moved out the day before Thanksgiving on 11/26/25. Therefore, the allegation above is Unsubstantiated. An Unsubstantiated complaint means, that 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. An exit interview was conducted with Caregiver Myrna Jackson and a copy of this report was provided at the conclusion of the visit. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 2, 2025 · control 56-AS-20251124161821

Allegation investigated: Staff does not treat residents with dignity or respect

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPA met with Administrator Dorris Anderson, and discussed the purpose of the visit. Regarding allegation above, LPA interviewed two (2) staff; both whom agreed they treat residents with dignity and respect. LPA interviewed five (5) residents, one (1) of the five (5) residents informed LPA they are treated with dignity and respect, four (4) of the five (5) residents were unable to provide LPA with detailed information due to their health conditions. Therefore, the allegation above is Unsubstantiated. An Unsubstantiated complaint means, that 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. An exit interview was conducted with Caregiver Myrna Jackson and a copy of this report was provided at the conclusion of the visit. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 2, 2025 · control 56-AS-20251126131126

Type of visit: Required - 1 Year

On 11/17/2025, Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Administrator Dorris Anderson, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (10), a current census of (8). LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility has no swimming pool or similar bodies of water. The facility has sufficient lighting and is maintained at a comfortable temperature of 72. The facility has sufficient indoor and outdoor space for resident activities The facility is equipped with operating smoke detectors/carbon monoxide alarms, laundry equipment, and telephone service. Resident’s showers, toilets, and hand washing areas were operating properly. The hot water temperature in resident bathrooms measured between 112 and 117 degrees F. Eight (8) resident’s bedrooms had beds, bed linen, chairs, dresser, storage space and sufficient lighting. The facility has sufficient linens, towels, and personal hygiene items for residents. The facility has posted in a common area, Administrator certificate, facility license, personal rights, facility sketch, emergency telephone numbers, CCLD complaint poster, and Ombudsman poster. Food Service: Facility kitchen and dining areas are maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care. Sharps and chemicals were kept locked and inaccessible to residents in care. Care & Supervision: Facility has 24 hour/7 days a week care staff. Facility staff have current CPR/first aid training. Medical Related Services: Resident’s medications are labeled and centrally stored in a locked cabinet. Record Review: Three (3) Staff files reviewed were observed to be complete. Three (3) Resident files reviewed were observed to be complete. Liability Insurance is valid through 01/16/2025-01/16/2026. Fire/Earthquake drill was conducted on 10/16/2025. Based on observations and record review no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Licensee/Administrator Dorris Anderson.the state’s words, verbatim · CDSS document, Nov 17, 2025

Allegation investigated: Facility staff did not assist resident with toileting in a timely manner. Facility staff are unable to communicate effectively with the residents. Facility staff did not ensure privacy to resident in care.

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Administrator Dorris Anderson, and discussed the purpose of the visit. Regarding allegation #1, LPA interviewed six (6) residents. Four (4) of the six (6) residents are independent and do not need assistance with toileting, all 4 residents have denied witnessing or hearing staff not assisting other residents with toileting needs in a timely manner. Two (2) of the six (6) residents interviewed need assistance with toileting needs, 1 of the 2 residents informed LPA staff attend to their toileting needs in a timely manner. R1 informed LPA last week, they were left in bed for over an hour and did not receive assistance with their toileting needs, however R1 stated when they are upset they tend to retaliate with staff. LPA interviewed an outside party and informed LPA they were on the phone during the alleged incident and R1 was refusing assistance from staff, due to being in a mood. Unsubstantiated LPA interviewed two (2) staff, both staff informed LPA they attend to residents and their toileting needs in a timely manner. Both staff informed LPA they attended to R1 the day of the alleged incident and R1 got upset and refused assistance. Regarding allegation #2, LPA interviewed 6 residents, 5 out of 6 residents stated the facility staff can communicate well with residents. 1 of the 6 residents stated S1 understands English, but can not speak it very well. LPA interviewed 2 staff, S1 informed LPA the residents have a routine, not much communication is needed, however they are able to communicate with residents fine. S1 informed LPA R1 can speak Spanish, but if they are in a bad mood they will refuse to speak Spanish. S2 informed LPA S1 cannot speak English fluently, however they are learning and can communicate well with the residents. S2 included the rest of the facility staff are able to speak English and communicate with residents just fine. Regarding allegation #3, LPA interviewed 6 residents. 5 out of 6 residents informed LPA they have privacy in the facility. 1 of 6 residents did not understand the question. LPA interviewed 2 staff, both have confirmed all residents have privacy while in care, residents are able to close their bedroom doors as well as having privacy while using the bathroom. Based on observation, interviews, and pertinent documents the allegations are unsubstantiated. An Unsubstantiated complaint means, that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted with Administrator Dorris Anderson and a copy of this report was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 3, 2025 · control 56-AS-20250926120025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a Health and Safety check. LPA met with Administrator Dorris Anderson, and discussed the purpose of the visit. LPA toured the facility, while LPA Ramirez was interviewing residents; LPA knocked on room #3 and no one answered. LPA peeked inside and noticed the room was fully furnished. LPA asked Administrator if Resident from room #3 was out in the community, Administrator informed LPA the tenant in room #3 was her ex-husband. Administrator stated the tenant was not fingerprinted. Based on observation, record review, and interviews deficiencies were cited per Title 22, Division 6 of The California Code of Regulations. An exit interview was conducted where the Licensing reports were discussed and copies of the reports with Appeal Rights was provided to Administrator Dorris Anderson.the state’s words, verbatim · CDSS document, Oct 3, 2025

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87355(e) · Plan of correction due date: Oct 6, 2025

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: This requirement was not met as evidenced by: Based on observation, record review, and interviews the Licensee did not comply with the section cited above by not having a background clearance for tenant(1)the state’s words, verbatim · CDSS document, Oct 3, 2025

Plan of correction: Licensee has agreed to either have T1 fingerprinted or evaluated and submit all required LIC documents to become a resident of the facility, Licensee will submit proof to LPA by POC due date.

Allegation investigated: Staff did not store food properly Staff does not ensure an adequate supply of food is maintained and accessible at the facility

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Administrator Dorris Anderson, and discussed the purpose of the visit. Regarding Allegation #1, LPA toured the facility and observed the main refrigerator in the kitchen had frosted over in the back of the refrigerator. LPA spoke with Administrator and LPA was informed the freezer is not properly working causing the frost. Administrator included the freezer drawer is being used as a refrigerator storing vegetables, while another freezer held all the frozen foods. Regarding Allegation #2, LPA did not observe an adequate number of fruits and vegetables for residents in care. The strawberries in the refrigerator observed to be growing mold. Substantiated Based on the evidence gathered during the investigation, the above allegations are Substantiated. A finding that the complaint is Substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. An exit interview was conducted where this report LIC 9099, LIC 9099D was discussed, and a copy was provided, along with a copy of the appeal rights to Administrator Dorris Anderson.the state’s words, verbatim · CDSS document, Mar 28, 2025 · control 56-AS-20250326095909

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Apr 5, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. Based on observation and interviews, the licensee did not ensure the facility to be in good repair at all times, which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 28, 2025

Plan of correction: Licensee has agreed to repair or purchase new refrigerator, and submit proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(a) · Plan of correction due date: Mar 29, 2025

87555 General Food Service Requirements(a)The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board... All food shall be selected, stored, prepared and served in a safe and healthful manner. Based on observation and interviews, the licensee did not ensure the facility had an adequate food supply for residents in care, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 28, 2025

Plan of correction: Licensee has agreed to purchase more fruits and vegetables and submit proof to LPA by POC due date.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a Health and Safety check. LPA met with Administrator Dorris Anderson, and discussed the purpose of the visit. LPA toured the facility and observed dead roaches in Resident #3 (R3) bedroom, the dead roaches were on roach strips on top of R3’s dresser. LPA asked R3 if they have roaches often, R3 informed LPA yes, they have roaches and the Administrator has a guy that comes to the facility to spray and inspect the interior and exterior once a month. LPA asked R1 if the facility has roaches and R1 also informed LPA that yes, the facility has roaches. R1 has seen one in their room, however R1 stated R3’s room has it worse with roaches. R4 informed LPA they do not have roaches in their room, nor have they seen any throughout the house. LPA overheard Administrator scheduling an inspector to come out to the facility on Monday 3/31/25 to spray. As LPA conducted interviews it was mentioned the facility does not provide activities for residents. LPA asked Administrator if activities are provided to residents and LPA was informed residents participate in activities at innovage three times a week. Therefore, no activities are not being provided to residents at the facility. Based on observation deficiencies were cited per Title 22, Division 6 of The California Code of Regulations. An exit interview was conducted where the Licensing reports were discussed and copies of the reports with Appeal Rights was provided to Administrator Dorris Anderson.the state’s words, verbatim · CDSS document, Mar 28, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Mar 29, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... Based on observation and interviews, the licensee did not ensure the facility to be kept clean, safe, and sanitary which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 28, 2025

Plan of correction: Licensee has scheduled an inspector to come to the facility and spray the entire faciliy, an invoice will be provided to LPA upon visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87219(a) · Plan of correction due date: Mar 31, 2025

87219 Planned Activities (a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities.. Based on observation and interviews, the licensee did not ensure the facility to participate in planned activities which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 28, 2025

Plan of correction: Licensee has agreed to create and follow the updated planned activite created for residents. An updated activities schedule will be sumitted to LPA by POC due date.

Allegation investigated: Staff are not ensuring that resident attends medical appointments.

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Dorris Anderson, Licensee, and discussed the purpose of the visit. The investigation consisted of Licensee, staff, resident, outside party interviews and pertinent document review. Regarding the allegation, staff are not ensuring that resident attends medical appointments, the Licensees’ interview reveals, resident #1 (R1) missed their doctor’s appointment due to not having help to transfer resident out of bed. Facility staff were not able to transfer R1 out of bed to attend their doctor’s appointment due to R1 being too heavy. Although R1 had transportation available for doctor’s appointments through an outside agency, drivers are not permitted to assist facility staff with out-of-bed transfers. LPA review of resident appraisal of services needed reveals, R1 needs help in transferring in and out of bed or chair. Based on evidence obtained during this investigation, the allegation is Substantiated. A substantiated finding means that the allegation(s) is valid because the preponderance of the evidence standard has been met. Substantiated An exit interview was conducted where reports (LIC9099&LIC9099-D) were discussed and provided with appeal rights to Licensee Anderson at the conclusion of the visit Based on Licensee, staff and resident interviews, the allegations mentioned in this report are Unsubstantiated; meaning that 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. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy with appeal rights was provided to Dorris Anderson at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 21, 2025 · control 56-AS-20230727155713

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Mar 24, 2025

Additional Personal Rights of Residents in Privately Operated Facilities(a)In addition to the rights listed in Section 87468.1...residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: The licensee did not comply with the section cited above by not ensuring R1 had adequate services and staff to meet their needs, which poses an immediate, health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 21, 2025

Plan of correction: R1 no longer resides at the facility. The Licensee shall review the regulation cited and provide a statement of understanding to the Licensing agency by POC due date.

Allegation investigated: Staff is not ensuring that resident is being fed an adequate amount of food portions.

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Administrator Dorris Anderson and explained the purpose of the visit. Regarding allegation staff is not ensuring that resident is being fed an adequate amount of food portions. LPA Ramirez conducted 6 resident interviews. 4 out of 6 residents informed LPA they are being fed adequate food portions and if they wish to have more food they could ask for more. 2 out of 6 residents informed LPA their food portions are often small. LPA conducted 4 staff interviews. 4 out of 4 staff informed LPA every resident is different regarding food portions, some eat more than others. However there's enough food for seconds and always remind residents they can ask for more. Unsubstantiated LPA interviewed 3 staff, and 3 out of 3 staff informed LPA, Administrator removed R1's cable box because from their understanding R1 is not paying for the cable service, not paying rent, and the cable box belongs to Administrator. Based on the evidence gathered during the investigation, the above allegation is SUBSTANTIATED. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations 87468.1 (3) from Personal Rights Division 6 Chapter 8 Article 08, is being cited on the attached LIC 9099 D. An exit interview was conducted where this report was discussed, along with LIC 9099D and a copy with appeal rights was provided to Administrator Dorris Anderson at the conclusion of the visit. Based on LPAs observations and interviews, the above allegation is Unsubstantiated; meaning that 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. An exit interview was conducted where this report was discussed and a copy was provided to Administrator Dorris Anderson at the conclusion of the visit.the state’s words, verbatim · CDSS document, Feb 20, 2025 · control 56-AS-20241122101015

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1 · Plan of correction due date: Feb 28, 2025

87468.1 Personal Rights of Residents in All Facilities. (a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:...(3)To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidence by Based on interviews, the licensee did not follow Personal Rights regulation for 1 out of 9 residents which, poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 20, 2025

Plan of correction: Licensee has agreed to read over the "Personal Rights of Residents in All Facilities" regulation and provide training to all staff regarding the violation of resident’s rights. Licensee will email LPA a copy of the training signed and dated by all staff by POC due date.

Allegation investigated: Staff did not ensure facility is kept at a comfortable temperature for residents in care

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPA met with Administrator Doris Anderson and discussed the purpose of the visit. Regarding allegation above. LPA conducted interviews with staff and residents, toured, and observed the facility. LPA observed the facility thermostat to read 69 and 70 degrees F. LPA Ramirez conducted 6 resident interviews, 2 out of 6 residents informed LPA the facility is cold. 2 out of 6 residents informed LPA the facility is kept at a good temperature, 2 out of 6 residents informed LPA the facility is cold sometimes, however they notify the staff when it's too cold and the temperature is adjusted. LPA was also informed the heater is turned on at night while residents sleep. LPA conducted 3 staff interviews, 2 out of the 3 staff informed LPA the facility is cold sometimes, however the Unsubstantiated temperature is kept within the regulation requirements. Staff informed LPA if concerns about the temperature are brought to attention they will notify the Administrator; staff also informed LPA the only person to adjust the temperature is the Administrator. 1 out of the 3 staff informed LPA the thermostat is turned off in the morning to ventilate the facility, however it does not remain turned off all day, with their permission staff is able to adjust the temperature to accommodate all residents in care. Based on LPAs observations and interviews, the above allegation is Unsubstantiated. A finding that complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and this report was discussed and provided to Administrator Doris Andersonthe state’s words, verbatim · CDSS document, Dec 2, 2024 · control 56-AS-20241127151903

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarina Ramirez made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Administrator Dorris Anderson, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (10), a current census of (9). LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility has no swimming pool or similar bodies of water. The facility has sufficient lighting and is maintained at a comfortable temperature. The facility has sufficient indoor and outdoor space for resident activities The facility is equipped with operating smoke detectors/carbon monoxide alarms, laundry equipment, and telephone service. Resident’s showers, toilets, and hand washing areas were operating properly. The hot water temperature in resident bathrooms measured between 110 and 114 degrees F. Eight (8) resident’s bedrooms had beds, bed linen, chairs, dresser, storage space and sufficient lighting. The facility has sufficient linens, towels, and personal hygiene items for residents. The facility has posted in a common area, Administrator certificate, facility license, personal rights, facility sketch, emergency telephone numbers, CCLD complaint poster, and Ombudsman poster. Food Service: Facility kitchen and dining areas are maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care. Sharps and chemicals were kept locked and inaccessible to residents in care. Continuation on LIC – 809C: Care & Supervision: Facility has 24-hour/7days a week care staff. Facility staff have current CPR/first aid training. Medical Related Services: Resident’s medications are labeled and centrally stored in a locked cabinet. Record Review: Three (3) Staff files reviewed were observed to be complete. Three (3) Resident files reviewed were observed to be complete. Based on observations and record review no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Care Staff Rose Marie Viernes.the state’s words, verbatim · CDSS document, Nov 15, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Dorris Anderson, Licensee and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE). License capacity of (10) non-ambulatory residents and a current census of (9). LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant: Indoor passageways are free of obstruction. The facility has sufficient lighting and is maintained at a comfortable temperature. Resident’s bathrooms were operating in safe and sanitary conditions. The hot water temperature in resident's bathrooms measured between 106 and 109 degrees F. Resident’s bedrooms have sufficient lighting and furniture in good repair. Facility has operating carbon monoxide alarms and telephone service. The facility has sufficient linen, towels, and personal hygiene items for residents. The facility has posted in a common area: Community Care Licensing complaint poster, Ombudsman poster, resident personal rights, Facility license, disaster evacuation plan and emergency telephone numbers. Yards/Outside: Outdoor passageways are free of obstruction. The facility has no bodies of water accessible to residents in care. The facility backyard is fenced and has sufficient space for resident activities. Food Service: Facility has sufficient non-perishable and perishable food supply for residents in care. The refrigerators and freezers are operating in a healthful manner. Pesticides and other cleaning solutions were kept locked and stored away from food areas. Care & Supervision: Facility has 24-hour, 7 days a week care staff. Staff working have criminal record clearances or exemptions through the Department. Record Review: The Licensee's Administrator's certification expires on 8/15/2024. (3) staff files reviewed were observed to be complete. (3) resident files were reviewed. Resident #1 (R1) did not have examination results for tuberculosis on file. Medical Related Services: All medications were centrally stored and kept in a locked cabinet inaccessible to residents in care. A deficiency is being cited per Title 22, Division 6 of The California Code of Regulations. An exit interview was conducted where a plan of correction and reports (LIC809/LIC809-D/LIC9102) were discussed with Licensee Anderson. Copies of the Licensing reports with Appeal Rights were provided to the Licensee at the conclusion of the visit.the state’s words, verbatim · CDSS document, Nov 18, 2023

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.