Footprint Care Home

Type of visit: Required - 1 Year

On 07/10/2026 at 8:40 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Direct Care Staff, Gene Messick and explained the purpose of the visit. LPA toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 2 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 109.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Carbon monoxide detector was in operating condition during visit. Fire extinguisher was last serviced on 03/10/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 03/10/2026. At 9:05 AM, LPA reviewed 2 residents records. At 9:28 AM, LPA reviewed 3 staff records and 3 of 3 have current first aid training and are associated with the facility. LPA reviewed 2 of 2 of residents’ medications. Continue to LIC809-C... Continued from LIC809... THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 9:48 AM, LPA observed unlocked prescribed ointment in R1's room. At 10:05 AM, LPA observed ants on one of the kitchen drawers filled with spices. At 10:34 AM, record review revealed that S2 and S3 do not have sufficient annual training for 2026. At 11:36 AM, LPA observed R2 bedridden. Per S2, R2 is bedridden and cannot move without staff assistance. At 11:40 AM, LPA observed the smoke alarm not functioning. At 11:49 AM, record review revealed there’s no doctor’s order for R2’s medications. At 12:01 PM, record review revealed that there’s no doctor’s order for R2. At 12:30 PM, LPA observed that the facility does not have a qualified administrator on duty. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Messick. Appeal Rights, LIC421FC, LIC421IM, and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 10, 2026

The state marks this report as 11 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 10/01/2025 2:15PM, Licensing Program Analyst (LPA) P.Manalo arrived unannounced to conduct a case management to follow up on the annual fees that are overdue and late fee assessment. LPA met with Gene Messick, and explained the purpose of the visit. Administrator gave verbal authorization for staff to sign the report. LPA discuss with ADM regarding the outstanding Annual Fee. ADM stated ADM will send confirmation of paid Annual Fee by 10/08/2025. No deficiency issue on today date. Exit interview is conducted and a copy of this report is provided.the state’s words, verbatim · CDSS document, Oct 1, 2025

Allegation investigated: Facility accepted a resident that requires a higher level of care. Facility staff is not tending to resident's health and care needs. Facility increased resident's fees without any notification to the responsible party.

On 07/15/2025, at 9:45 AM, Licensing Program Analysts (LPAs) P. Manalo and K. Nguyen arrived unannounced to conduct a complaint investigation and deliver findings on the above allegations. LPAs met with Direct Care Staff, Gene Messick and explained the purpose of the visit. During the course of investigation, LPAs interviewed 3 staff and witness. LPAs reviewed documents including but not limited to Resident 1’s (R1’s) Admission Agreement, Appraisal Needs and Services Plan, After-Visit Summary, Identification and Emergency Information, Pre-Appraisal Evaluation, and Progress Notes. Continue to LIC9099-C... Substantiated Continue from LIC9099... It was alleged that facility accepted a resident that requires a higher level of care. Interviews with staff all indicated they are not capable of providing the level of care that R1 needs. All staff stated that they have not received any training regarding R1’s care and the care should be done by a licensed professional. It was alleged that facility staff is not tending to resident’s health and care needs. Record review of the After Visit Summary showed that R1 has been in and out of the hospital numerous times dated from October 2024 to July 2025. Interviews with S2 and S3 revealed that the facility obtains the After-Visit Summary after the resident returns from the hospital. However, they do not follow up with the after-care instructions from the summary to provide care for R1. Interview with W1 disclosed that R1 has been to the hospital multiple times since R1’s admission to the facility for R1’s health condition. It was alleged that facility increased resident's fees without any notification to the responsible party. A review of R1’s Admission Agreement dated 07/19/2024 showed that the facility was charging the resident for a private room without a break down of how much each services cost. LPA interviewed W1 and stated that the facility increased R1’s rent without proper notice for R1 residing in the private room. W1 stated that there is no documentation of the increase of rent nor the breakdown of the services. Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Jul 15, 2025 · control 15-AS-20250714143536

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1568.03 · Plan of correction due date: Aug 6, 2025

(b) ... a facility shall not accept or retain residents who require a higher level of care than the facility is authorized to provide. Persons who require 24-hour skilled nursing intervention shall not be appropriate for a residential care facility. This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above by retaining a resident who needs a higher level of care which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 15, 2025

Plan of correction: The Administrator will work with the resident and resident's POA on finding another placement for resident that can provide the resident's care needs. Proof of correction will be sent to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jul 30, 2025

(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: Based on interview, the licensee did not comply with the section above by not providing residents with basic care needs which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 15, 2025

Plan of correction: The Administrator agrees to self certify and review the resident's care plan. Proof of correction will be sent to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655 · Plan of correction due date: Jul 30, 2025

(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 90 days’ prior written notice... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section above by not providing the resident an increase notice of rent which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 15, 2025

Plan of correction: The Administrator will self-certify the regulation and send proof to CCLD by POC date.

Type of visit: POC

On 07/15/2025 at 12:45 PM, Licensing Program Analysts (LPAs) P.Manalo and K.Nguyen arrived unannounced to conduct Proof of Correction (POC) visit. LPA met with Direct Care Staff, Gene Messick, and explained the purpose of the visit. On 06/25/2025, LPA P.Manalo conducted an Annual Inspection in which deficiencies were cited. The POC due date was on 07/02/2025 and 07/08/2025. Facility has the following deficiencies that was not cleared: Health and Safety 1569.618(c)(3) due on 07/02/2025 Health and Safety 1569.625(b)(2) due on 07/08/2025 CCR 87412(g) due on 07/08/2025 CCR 87506(b) due on 07/08/2025 CCR 87608(a)(5)(A) due on 07/08/2025 Civil penalty of $1,250 is being assessed today. Exit interview conducted. A copy of this report, LIC421FC, and appeal rights provided.the state’s words, verbatim · CDSS document, Jul 15, 2025

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.618(c)(3) · Plan of correction due date: Jul 23, 2025

(c).... (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by not having CPR and/or First Aid certification for the Administrator which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 15, 2025

Plan of correction: Staff agrees to obtain First Aid and CPR certification for all the staff and send proof to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.625(b)(2) · Plan of correction due date: Jul 30, 2025

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, ...This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by not having training for the Administrator which poses a potential health and safety to persons in care.the state’s words, verbatim · CDSS document, Jul 15, 2025

Plan of correction: Staff agrees to obtain training for all the staff and send proof to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(g) · Plan of correction due date: Aug 6, 2025

(g) All personnel records shall be maintained at the facility. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by not having the completed staff files at the facility which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 15, 2025

Plan of correction: The staff agrees to obtain and complete all staff files. Proof of correction will be sent to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(b) · Plan of correction due date: Aug 6, 2025

(b) Each resident’s record shall contain at least the following information: This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by not have the completed files for resident's which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 15, 2025

Plan of correction: The Administrator agrees to complete the residents' file and send proof to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(5)(A) · Plan of correction due date: Aug 6, 2025

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above by not having a half bed rail order for R1 and R2 which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 15, 2025

Plan of correction: The staff agrees to get a doctor's order for R1 and R2's half bed rail and send proof to CCLD by POC date.

Type of visit: Case Management - Other

On 07/15/2025 at 3:10 PM, Licensing Program Analysts (LPAs) P.Manalo and K. Nguyen arrived unannounced to conduct Proof of Correction (POC) visit. LPA met with staff, Gene Messick and explained the purpose of the visit. During the annual inspection conducted on 06/24/2025, the facility was issued a citation on the water temperature measured at 131.5 degrees Fahrenheit. The facility did not provide proof of correction. During today's visit, the water temperature was measured at 120 degrees Fahrenheit. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 15, 2025

Type of visit: Case Management - Other

On 07/15/2025 at 2:00 PM, Licensing Program Analysts (LPAs) P.Manalo and K.Nguyen arrived unannounced to deliver the complaint finding for Complaint # 15-AS-20250714143536 dated 07/15/2025. As a result, LPA conducted a case management. LPA met with care staff, Gene Messick, and explained the purpose of the visit. During interview with staff, it was revealed that the Administrator is not present and available in the facility for sufficient number of hours and/or days. Record review also showed that Resident 1 (R1) was sent to the hospital multiple times and was not reported to licensing agency. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Jul 15, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Aug 23, 2025

(a) ...The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours… This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above by not having the administrator at the facility for a sufficient number of hours which poses a potential safety risk in persons in care.the state’s words, verbatim · CDSS document, Jul 15, 2025

Plan of correction: The Administrator agrees to send an updated LIC500 for all the staff, send Administrator time sheet every week for a month, and be available for phone call when licensing calls. Proof of correction will be sent to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: Jul 23, 2025

(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below... This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above by not reporting any incidents regarding residents which poses a potential health and safety risks to persons in care.the state’s words, verbatim · CDSS document, Jul 15, 2025

Plan of correction: The Administrator will self-certify and have in-service training for all staff regarding the regulation and send proof to CCLD by PC date.

Type of visit: Required - 1 Year

On 06/24/2025 at 8:45 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Direct Care Staff, Gene Messick, and explained the purpose of the visit. Administrator gave authorization for staff to sign the report. LPA toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 3 bedrooms are occupied by the residents and 2 bedroom is occupied by staff. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Residents’ bathrooms are equipped with grab bars and non-skid mats. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 07/26/2024. At 9:27 AM, LPA reviewed 1 staff record. The other 2 staff records were not at the facility for review. At 9:37 AM, LPA reviewed 3 residents records. At 11:00 AM, LPA reviewed a sample of resident’s medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 07/02/2025: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report Liability Insurance Continue to LIC809-C... Continue from LIC809... THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 9:04 AM, LPA observed unlocked medication in the kitchen fridge. At 9:10 AM, LPA observed canned food in the same storage area as laundry detergent, Ajax cleaning supply, dish soap, Febreeze, etc. At 9:11 AM, LPA observed the left side gate locked with a Masterlock and a wooden board and the right side locked with a metal chain. Civil Penalty of $500 is assessed. At 9:37 AM, staff records were not at the facility for review. Civil Penalty of $250 is assessed. At 9:37 AM, LPA did not observe any staff training. At 10:09 AM, record review showed that R2 and R3’s files were incomplete. At 10:14 AM, observation and record review showed that R1 and R2 with half bed rails and no doctor's order. At 10:24 AM, LPA observed the hot water temperature measured at 131.5 degrees F. At 10:58 AM, record review revealed that all staff did not have First Aid and/or CPR Certification. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Direct Care Staff. Appeal Rights, Civil Penalty, and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 24, 2025

Type of visit: Required - 1 Year

On 07/15/24 at 09:05 am Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to do an annual inspection. LPA meet with Staff Rosario Cunningham and explained the purpose of the visit. LPA inspected the facility inside out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use. Food supplies checked and observed good for seven days of non-perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Cabinet for knives, cleaning supplies, and central storage for medications were observed with locks. Activity supplies were available. Outdoor activity space was observed furnished with tables, chairs and shade. The facility has a mitigation plan. At 9:17 am LPA reviewed 3 residents records. At 9:45 am. The following deficiency was observed during the visit: The staff records were not at the facility The Facility was cited, and citations can be found on the LIC 809-D. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 15, 2024