Familycare Cottage One

Allegation investigated: Licensee did not provide responsible party with a refund as required

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent complaint visit to investigate the above-listed allegation. Upon arrival at approx. 10:12a.m. LPA was greeted by staff who called the Administrator and the reason for the visit was explained. The LPA met with Debra Bryant, Licensee Representative, Marisol Flamenco, Administrator and Magdalena "Maggy" Garcia, Assistant Administrator, and reason for the visit was explained. Entrance interview conducted. On 02/12/2026, the Department received a complaint regarding the following allegation, Licensee did not provide responsible party with a refund as required. On 02/12/2026 LPA Esther Cortez conducted an unannounced initial complaint visit, conducted a physical plant tour, conducted three (3) in-person, staff interviews, a file review for Resident #1 (R1), and obtained copies of pertinent documentation relevant to the investigation. Report continued on LIC 9099-C PAGE 2... Substantiated (PAGE 2) Report continued from LIC 9099... During today's visit starting at 10:20 a.m. LPA and staff briefly toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, starting at 10:35 a.m. conducted two (2) telephonic interviews with the Parties Responsible (PR) for R1, at 11 a.m. conducted an in-person interview with the facility Administrator, at 1:20 p.m. conducted an in person interview with the facility Licensee representative and obtained copies of pertinent documentation relevant to the investigation. On the allegation, Licensee did not provide responsible party with a refund as required, it is the concern of the Reporting Party (RP) that R1’s PR did not receive the refund check within the required 15 days after the room was vacated. To investigate this complaint, LPA conducted in person interviews, telephonic interviews, file and record review and obtained copies of pertinent documentation relevant to the investigation. File and Record review revealed that R1 moved into the facility on 09/18/2017, passed away on 11/08/2025, and moved out on the same day 11/08/2025. Administrative staff interviews revealed that R1 moved into the facility on 09/18/2017, passed away on 11/08/2025 and move out on the same date. To their knowledge the facility has a bookkeeper who handles all facility finances. To their knowledge R1 was paying $6,200 monthly for room and board and an additional $300 for incontinent supplies. There is an ongoing unrelated legal matter with the same family and to their knowledge it is the reason why the refund has not been issued. As of today, the refund has not been issued. Interview with the facility licensee representative revealed that there is an ongoing unrelated legal matter with the R1’s family. Due to the legal matter, they believe they should not have to pay the refund since they are still owed money by the family. Interviews with PR revealed that they have tried numerous times to get in contact with the facility owner, however, have been unsuccessful. They are aware of an unrelated matter with their family members, however, note that it is unrelated to R1 and their refund. Based on information gathered during the course of the investigation, and interviews there is sufficient evidence to support the allegation occurred. Therefore, the allegation of Licensee did not provide responsible party with a refund as required is deemed SUBSTANTIATED at this time. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiency was cited (refer to LIC 9099-D.) Administrator was informed that failure to correct the deficiency may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 4, 2026 · control 29-AS-20260212110309

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Mar 18, 2026

§1569.652 Termination of admission agreement upon death of resident... and refunds (c) A refund of any fees paid in advance...shall be issued...to the resident’s estate, within 15 days after the personal property is removed.This requirement is not met as evidenced by Based on interviews and record review, the facility did not comply with the above cited section, as R1 passed away on 11/08/25, belongings were removed on 11/08/25 and no check has been issued, which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 4, 2026

Plan of correction: Licensee representative will issue a refund for the amount of $4,546.66 based on the $6,200 paid montly for room and board by POC due date.

Allegation investigated: Facility staff refused to return resident's personal items upon move out Facility staff did not allow resident's authorized person to make decisions regarding resident's care

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent complaint visit to investigate the above-listed allegations. The purpose of this visit is to deliver findings for the above listed allegations. Upon arrival at approx. 1:15 p.m. LPA was greeted by staff who called the Administrator and the reason for the visit was explained. The LPA met with Magdalena "Maggy" Garcia, Assistant Administrator (AA) and reason for the visit was explained. Entrance interview conducted. On 12/17/2025, the Department received a complaint regarding the following allegations, Facility staff refused to return resident's personal items upon move out and Facility staff did not allow resident's authorized person to make decisions regarding resident's care. On 12/19/2025 starting at 1:13 p.m. LPA and staff briefly toured the physical plant areas inside and outside, starting at 1:30 p.m. and throughout the visit LPA conducted three (3) in-person, staff interviews, conducted a file and record review for Resident #1 (R1), at 2:54 p.m. conducted a telephonic interview with Power of Attorney (POA) #1 and obtained copies of pertinent documentation relevant to the investigation. Report continued on LIC 9099-C PAGE 2... Unsubstantiated (PAGE 2) Report continued from LIC 9099... On 01/13/2026 conducted the following telephonic interviews at 3:20 p.m. with Facility owner, at 3:47 p.m. with Long Term Care Ombudsman (LTCO), at 3:52 p.m. with Power of Attorney (POA) #2 at 3:04 p.m. and at 3:06 p.m. attempted to contact POA #1 on mobile and home phone numbers. On 01/27/2026 conducted the following telephonic interviews at 2:46 p.m. with facility Administrator at 3:58 p.m. with relocated facility Administrator. During today's visit starting at 1:20 p.m. LPA and staff briefly toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, and obtained copies of pertinent documentation relevant to the investigation. On the allegation, Facility staff refused to return resident's personal items upon move out, it is the concern of the Reporting Party (RP) that the facility refused to release R1’s personal belongings, including furniture, clothing, wallet, and television. To investigate this complaint, LPA conducted in person interviews, telephonic interviews, file and record review and obtained copies of pertinent documentation relevant to the investigation. Interviews with POA #2 revealed that on 12/12/2025, they became the POA for R1, revoking the POA status of POA #1. On 12/16/2025, POA #2 texted the POA paperwork to the facility AA. Later that morning, POA #2 arrived at the facility and informed the AA that R1 would be moving out. POA #2 stated that the AA did not respond to the text message but acknowledged receiving the document during the move-out process. At that time, large furniture items were not released, and POA #2 left the facility with R1. On 01/13/2026, POA #2 confirmed that all items were picked up by the relocated facility on 12/19/2025. Interview with POA #1 revealed that they obtained POA for R1 on 12/10/2012. POA #1 provided a letter from R1’s neurologist dated 11/03/2025, stating that R1 currently lacks the capacity to make independent financial and medical decisions. POA #1 indicated that they are currently involved in litigation to resolve the POA status for R1. Additionally, they were advised that their attorney will contact the facility to provide recommendations regarding the furniture and will follow the appropriate guidelines on how to proceed. Report continued on LIC 9099-C PAGE 3... (PAGE 3) Report continued from LIC 9099-C page 2... Interviews with facility administrative staff revealed that R1 was admitted to the facility on 11/14/2025 by POA #1 and moved out on 12/16/2025 by POA #2. The Administrator Assistant (AA) stated that on the morning of 12/16/2025, POA #2 texted them a document. At approximately 8:40 a.m., POA #2 arrived at the facility and informed the AA that they had sent updated POA documentation and were now the POA for R1. POA #2 also stated that R1 would be moving out that day and began the move-out process. The facility was unsure how to proceed and contacted POA #1, Adult Protective Services (APS), the Long-Term Care Ombudsman (LTCO), and licensing for guidance. APS arrived on-site and advised the facility that the matter was civil and should be handled by the attorneys. POA #1 informed the facility that they were unaware of any changes regarding R1’s POA status and noted that they had previously submitted documentation from R1’s neurologist stating that R1 was not capable of making informed decisions, which was the basis for the POA being in place. The facility owner stated they were uncertain about the validity of the updated POA documentation since it was only texted that morning. During the move-out, POA #2 and Witness #1 (W1) became aggressive, shouting at staff and banging on walls and doors. The facility owner contacted law enforcement, after which POA #2 and R1 left, leaving large furniture items behind. Law enforcement advised the facility that the situation was a civil matter and to await attorney guidance regarding the remaining items. Administrative staff reported that later that same day, the relocated facility’s Administrator called to schedule a pickup. The facility owner stated that they coordinated the pickup and confirmed that the items were collected, noting that having the relocated facility retrieve the items was the best solution since they knew the items were going to R1. Interview with the LTCO revealed that R1’s personal belongings were in their possession on the day R1 moved into the relocated facility. The only items not obtained at that time were large furniture pieces; however, these were later recovered by the relocated facility. Files and records reviewed revealed that R1 moved into the facility on 11/14/2025. POA documentation dated 12/10/2012 lists POA #1. A neurologist’s letter dated 11/03/2025 indicates that R1 carries a diagnosis of Alzheimer’s disease and currently lacks the capacity to make independent financial and medical decisions. POA documentation dated 12/12/2025 lists POA #2. Facility records indicate that R1’s belongings were released to the relocated facility on 12/23/2025. Report continued on LIC 9099-C PAGE 4... (PAGE 4) Report continued from LIC 9099-C page 3... Although the allegation may have happened or are valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegations of Facility staff refused to return resident's personal items upon move out is deemed unsubstantiated at this time. On the allegation, Facility staff did not allow resident's authorized person to make decisions regarding resident's care it is the concern of the Reporting Party (RP) that the facility did not include POA#2 in care decisions for R1. To investigate this complaint, LPA conducted in person interviews, telephonic interviews, file and record review and obtained copies of pertinent documentation relevant to the investigation. Interviews with POA#2 revealed that they obtained POA for R1 on 12/12/2025. Prior to that date, POA#1 held the authority. R1 was admitted to the facility on 11/14/2025, and all documentation and care planning were completed with POA#1. On the morning of 12/16/2025, POA#2 texted the AA the POA documentation. Around 8:40 a.m., POA#2 arrived at the facility and informed staff that R1 would be moving out. On 01/13/2026, POA#2 stated they were unaware of any care planning, as R1 had moved out on 12/16/2025. Interviews with facility administrative staff confirmed that R1 was admitted on 11/14/2025 and all documentation and care planning were completed with POA#1. On 12/16/2025, the AA received a text message from POA#2 with the POA document. That same day, facility staff were informed that R1 would be moving out and noted the updated POA status to the AA. All of R1’s care planning was completed upon admission on 11/14/2025. No additional care planning was conducted on or after 12/16/2025. Although the allegation may have happened or are valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Facility staff did not allow resident's authorized person to make decisions regarding resident's care is deemed unsubstantiated at this time. Exit interview conducted. Report was reviewed and a copy was provided.the state’s words, verbatim · CDSS document, Jan 29, 2026 · control 29-AS-20251217145251

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 10 a.m. Upon arrival, LPA Mosley was greeted by staff and Assistant Administrator, Magdalena Garcia and the reason for the visit was explained. The Administrator, Marisol Flamenco arrived shortly after and the reason for the visit was explained. Entrance interview. The LPA and Assistant Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: This includes the living room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 2:08 p.m., hardwire combination of smoke / carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 07/17/2025. The emergency exiting plans/sketch is posted. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 08/13/2025 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened. There is a functioning telephone on the premises. Auditory alarms at the entrances and exits were observed and functional at the time of the visit. BEDROOMS: There are five (5) total bedrooms in the facility; four (4) bedrooms are designated as private, single occupancy, resident rooms and one (1) shared, double occupancy, resident room. There is no staff room and Administrator stated that staff remain awake at night. Two (2) out of four (4) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... RESTROOMS: There are three (3) total restrooms. Two (2) are designated as a shared / common resident restrooms, and one (1) is designated as a private resident restroom. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 108.1-108.7 degrees Fahrenheit, all within the required range. LPA observed storage space closets in hallway containing extra clean linens and towels for resident use. BACKYARD: The entire property is fenced. The backyard has a covered patio area with shade, patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. Only 1 (one) pathway is used as an emergency exit which was free of obstructions at the time of the visit. LPA advised staff that the fence is starting to tilt inward and it will need to be replaced or repaired soon. Staff noted that they are in the process and have communicated with the neighbors regarding the fence arrangements. KITCHEN: The LPA inspected the kitchen/food service area at 10:27 a.m. Knives and sharps were observed in a locked cabinet. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 108.7 degrees Fahrenheit at 10:28 a.m. Cleaning supplies and other chemicals are kept locked under the sink and inaccessible to residents in care. LPA observed a locked medication cart in the kitchen. INTERVIEWS: Starting at 10:35 a.m. and throughout the visit one (1) staff and two (2) resident interviews were conducted. Staff interview revealed that staff is knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interview revealed that no concerns were noted or voiced at the time of the visit. GARAGE: LPA observed the garage to be inaccessible to residents in care. LPA observed the garage to contain the facility’s emergency food supplies, the facility’s washer and dryer, and locked storage for laundry chemicals. LPA observed an extra refrigerator containing extra food that was checked for proper labels and expiration dates. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... RECORDS: Resident Records: were reviewed beginning at 10:35 a.m. Five (5) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records were in order. Personnel Records were reviewed beginning at 11:51 a.m. five (5) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices, plan and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. MEDICATIONS: Medication review began at approximately 12:48 p.m. Medications are centrally stored and locked in a medication cart located in the kitchen adjacent to the dining room. Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. DOCUMENTS: Documents obtained during the visit include: LIC 500 - facility roster, LIC 9020A - Resident roster and copy of the current Limited Liability insurance. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, Oct 2, 2025

Allegation investigated: Resident developed maggot infested wound while in care of staff.

Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to the facility. The purpose of the visit is to deliver investigation finding. Upon arrival LPA met with Marisol Flamenco and explained the reason for the visit. Entrance interview conducted. On 07/23/2024, Community Care Licensing Division (CCLD) received a complaint with the above allegation. Investigation was initiated on 08/02/2024; at approximately 9:45a.m., a physical plant tour was conducted with administrator. Resident and staff records were reviewed at approximately 10a.m. and interviews were conducted with staff at 11:30a.m. Pertinent documents were requested and received on 08/06/2024. Following is a summary of the investigation finding: Regarding allegation, “Resident developed maggot infested wound while in care of staff.” – It was alleged that due to improper wound care by staff, resident #1’s (R1) wound on the left side of the face was infested with maggots. (Continue to LIC9099c) Unsubstantiated Records obtained from facility and Oakhurst Heritage Hospice was reviewed and revealed that R1 did not have an open wound. Records reviewed and interview conducted with hospice nurse revealed that R1 had a facial growth (quarter size) which was being treated by hospice and wound care specialist. Between the hospice nurse visit and wound care nurse R1 was seen three times a week;-twice a week from hospice and once a week by the wound care specialist. According to administrator and staff they observed change in R1’s condition (wound/growth) and it was immediately reported, and medical attention was provided. Administrator and staff stated that it was not there duty to clean R1’s wound and they would only observe and report to hospice. Interviews conducted confirmed that hospice and a wound care specialist was treating the growth on R1's face. Staff interviewed stated that R1’s wound was covered and only hospice would change the dressing. Records reviewed confirmed that R1 was last seen by hospice nurse on 07/17/2024; hospice notes reviewed indicated that R1’s growth was increasing in size and not getting better; however, there was no drainage noted. According to hospice nurse facility staff reported the incident immediately and were instructed to call 911. R1 was take to the hospital for further evaluation. According to hospice nurse facility staff did not provide any type of wound care. Additional interviews were conducted during today's visit with potential witnesses regarding the facility staff care services. All interviewed reported being satisfied with the care services provided by the facility staff. Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the above allegation “Resident developed maggot infested wound while in care of staff.” is deemed UNSUBSTANTIATED at this time. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jan 29, 2025 · control 29-AS-20240723124722

Allegation investigated: Staff falsify training records Staff do not ensure facility is free from pests Dishwasher is in disrepair

Licensing Program Analyst (LPA) Kelly Dulek conducted an initial complaint investigation for the allegations listed above. LPA arrived at the facility at 11:15AM and was greeted by facility staff. LPA met with Facility Designee Marisol Flamenco. Entrance interview conducted. During today’s visit, LPA interviewed staff and Facility Designee from 11:17AM to 11:55AM, toured the facility with Facility Designee at 11:57AM and LPA reviewed and obtained copies of pertinent documents. The following was then determined: Allegation "Staff falsify training records:" The complaint alleges that staff are not trained annually as required. LPA interviewed facility staff, who indicated they are trained as required. Staff indicated they have completed trainings and that hospice nurses Report Continued on LIC 9099-C Unsubstantiated and facility staff provide ongoing training. LPA observed training binders including signed documents indicating staff have received training monthly. During the visit, LPA and Facility Designee attempted to contact the hospice nurse who provided most training, however nurse was unavailable. 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 “staff falsify training records” is deemed UNSUBSTANTIATED at this time. Allegation "Staff do not ensure facility is free from pests:" During the facility tour, LPA observed a rodent trap in the garage, but no droppings or other evidence of pest infestation. Facility Designee indicated that the facility has ongoing monthly pest control as a preventative measure against pests, which includes the rodent trap observed. LPA observed all kitchen cabinets, crevices, and behind all appliances and did not observe any insects or droppings. Staff interviewed indicated they had in the past seen pests, but not recently. 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 “staff do not ensure facility is free from pests” is deemed UNSUBSTANTIATED at this time. Allegation "Dishwasher is in disrepair:" Interview with Facility Designee revealed that management had purchased a new dishwasher for the facility about 1 year ago. The dishwasher is functional, but that facility staff choose to wash most dishes by hand. During the visit, the Facility Designee turned on the dishwasher at 12:05PM and LPA observed the dishwasher to be functional at the time of the visit. 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 “dishwasher is in disrepair” is deemed UNSUBSTANTIATED at this time. No citations issued. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Nov 26, 2024 · control 29-AS-20241121091701

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 10:20AM. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Marisol Flamenco arrived shortly thereafter. Entrance interview conducted. Beginning at 10:40AM, the LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguisher was observed to be fully charged and Administrator stated was recently purchased, around the time of LPA Chochian's last visit. LPA Dulek advised Administrator to retain proof of purchase date. All combination smoke and carbon monoxide detectors were functional during testing. KITCHEN/GARAGE: The LPA began the inspection in the kitchen/food service area. One knife and one lighter were observed in a small drawer next to the stove, which was unlocked and accessible to residents in care. Items were secured in a locked location upon discovery. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Adjacent to the kitchen is the facility garage. The garage was observed to be locked and contains emergency food and water, extra food, cleaning supplies, and laundry. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature throughout the visit. Auditory alarms on exit doors were observed to be functioning at this time. The LPA observed required postings throughout the common space. BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 5 (five) designated resident rooms; 4 (four) are private rooms and 1 (one) is a Report Continued on LIC 809-C shared resident room. There was a linen closet in the hallway with extra towels and linens. RESTROOMS: The facility contains 3 (three) restrooms. 1 (one) full restroom and 1 (one) half bath are located in the hallway and are designated for shared use. 1 (one) restroom is located in a private resident room, however is utilized by another resident, as it contains an accessible shower and the common restroom does not. Resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature initially measured low, however was retested later when the washing machine cycle had completed and measured at 107.4 degrees Fahrenheit. RECORDS: Records review began at 11:04AM; records were reviewed for, but not limited to: care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 01:19PM; LPA reviewed medications for 2 (two) residents. Medications are centrally stored and locked in a medication cart in the kitchen; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: The facility has an infection control plan and emergency disaster plan; both of which were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly, with the last drill documented on 08/13/2024. INTERVIEWS: During today's visit, LPA conducted interviews with both staff and residents. No concerns were noted during interviews. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 23, 2024

Allegation investigated: Medication is not being administered as prescribed.

Licensing Program Analyst (LPA) Teresa Camara conducted an initial complaint investigation visit. LPA met with licensee/administrator Debra Bryant and explained the reason for the visit. LPA interviewed the licensee at 9:10 a.m. LPA interviewed staff 1 (S1) at 10:10 a.m. while also reviewing the medications for all residents. LPA interviewed staff 2 (S2) at 10:52 a.m. There was a suspicion of former staff mishandling medication for residents in one of the other homes owned by the licensee. However, all medications at this facility appear to be given as prescribed. The staff LPA interviewed had not witnessed or suspected any medication mishandling at this facility. Based on the medication review and interviews, the allegation medication is not being administered as prescribed is deemed UNSUBSTANTIATED at this time. No defiiciencies cited. Exit interview conducted and report issued. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 18, 2024 · control 29-AS-20240110170429

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit at 10:30 a.m. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Chrissy Cortez arrived shortly thereafter. The LPA and staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: The LPA began the inspection in the kitchen/food service area at 10:30 a.m. Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The LPA observed expired milk and cheese. Administrator discarded immediately upon discovery and replaced items at the time of the visit. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 75 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was fully charged and was last purchased on 5/23/2023. The LPA observed required postings throughout the common space. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single-latched. No bodies of water noted. The garage is where the washer and dryer are held, including additional non-perishable food items. Cleaning supplies and disinfectants are kept in locked cabinets in the garage. The garage is locked and inaccessible. BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are five designated client rooms. There was a linen closet in the hallway with extra towels and linens. **Continued on LIC 809-C** RESTROOMS: The 2 1/2 resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured in the hallway restroom at 112.4 degrees Fahrenheit. RECORDS: Residents’ records review began at 12:38 p.m., records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 2:20 p.m.; medications are centrally stored and locked in a medication cart in the kitchen; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 13, 2023