Generous Homecare

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs) Andrew Martinez and Becky Mann conducted an unannounced Case Management visit at the facility to follow up on an Incident Report regarding the adult death of Resident #1 (R1)'s which occurred on 6/10/2026. LPAs introduced themselves and were granted entry by facility staff. Administrator/Licensee Marie Libed was contacted by staff to inform them of LPAs presence and Administrator arrived shortly after. LPA spoke with the Administrator/Licensee Marie Libed to obtain additional information regarding the death and complete a health and safety check. LPAs reviewed R1’s facility file and obtained copies of the following documents: Resident Identification and Emergency Information, admission's agreement, physician's report, preplacement appraisal, individual service plan, centrally stored medication log, hospice records, and special incident report/death report. LPAs toured the inside and outside of the facility and there were no imminent health or safety concerns observed at time of visit. LPAs advised Administrator/Licensee Marie Libed to send a copy of the death certificate to Community Care Licensing Division (CCLD) San Bernardino Adult & Senior Care Regional Office as soon as it is available. Further investigation may be required depending on the cause of death. No deficiencies were cited during the visit. An exit interview was conducted where this Facility Evaluation Report (LIC 809) was discussed and a copy provided to Administrator/Licensee Marie Libed.the state’s words, verbatim · CDSS document, Jun 25, 2026

Allegation investigated: Due to staff neglect, resident sustained multiple skin and pressure injuries. Staff administered oxygen to resident without physician's order.

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings of complaint investigation. LPA met with Facility Administrator Marie Libed. Allegation #1 - Due to staff neglect, resident sustained multiple skin and pressure injuries. On April 29, 2021, the Department received a complaint with allegation of personal rights violation resulting in R1 sustaining multiple skin and pressure injuries. The Department investigation consisted of review of facility and other records, observations, and interviews with pertinent individuals. Per facility records, R1 was admitted to the facility on or around May 2019. According to physician report completed around this time, R1 did not have skin or pressure injuries. In addition, records indicated that R1 did not have capacity for self-care in areas including bathing, dressing, incontinent care, and medication administration. R1 was non-ambulatory with use of walker and needed assistance in transferring to and from bed. Substantiated R1 admission agreement indicated services to be provided included continuous care and supervision, monitoring for resident changes in physical, mental, emotional and social functioning, assistance with daily living activities including mobility tasks, dressing, bathing, toileting, assistance with eating, and medication administration. Per interviews, on or around early January 2021, R1 had shown decline in health and had become reliant on wheelchair and being in bed more. Interviews also revealed that R1 had developed redness and then what was described as a “bed sore” was observed on coccyx area. Following observations of R1 health decline, Licensee (S1) reported that plan was to care for coccyx area, reposition R1 during the day and night, and increase hydration. Medical assessment of the area took place on or around February 12, 2021. At that time, R1 had multiple pressure injuries including Stage III wound to the left buttocks, Stage III wound to the left sacral area, and Stage III wound to the right sacral area. Despite additional instructions to facility staff to reposition R1 every 2 hours to prevent further skin breakdown, interviews revealed that repositioning did not occur as required. In addition, there was no documented written record of the care and services R1 was to receive due to changes observed. Subsequently, R1 developed additional skin injuries. According to medical records, on or around April 2, 2021, R1 was observed to have the following injuries; Right Sacrum, Left Sacrum, Left Lower Buttocks Skin Tear, Left Ankle Deep Tissue Injury (DTI), Left Heel DTI, Right Ankle DTI. On or around April 7, 2021, medical records indicated that R1 “has a chronic lower leg ulcers and sacral pressure ulcers due to immobility that has progressed slowly and not healed spontaneously that requires surgical debridement and continued wound management.” Wound Description indicates Site 1 is a Stage III located on the Sacrococcygeal, Site 2 is a State III located on the Left Medical Gluteal, Site 3 is Chronic ulcer of skin Fat Layer Exposed located on Left Lateral Ankle, Site 4 is Chronic Ulcer of Skin Fat Layer Exposed located on Left Lateral Lower Leg. Per Title 22 Regulations, "Pressure Injury" means localized damage to the skin and/or soft tissue under the skin that is usually over a bony part of the body or related to a medical or other device. This damage can appear as intact skin or an open ulcer and may be painful. It occurs because of intense and/or prolonged pressure on the affected part of the body or pressure combined with shear (an action or stress that causes internal parts of the body to become deformed). Based on appearance and severity, the damage to tissue is a Stage 1, 2, 3, or 4 pressure injury. According to regulations, Stage 3 pressure injuries are prohibited health conditions which shall not be accepted or retained in a residential care facility for the elderly. Based upon Department investigation, the allegation that due to staff neglect, R1 sustained multiple skin and pressure injuries is substantiated. Facility staff did not ensure that R1 received the care needed to meet R1 needs. R1 was admitted to facility with no pressure injuries. Prior to or around January 2021, R1 had developed redness and then what was described as a “bed sore” was observed on coccyx area, but facility staff neglected to obtain assistance for care. R1 was diagnosed with multiple pressure injuries on February 12, 2021. Subsequent injuries to R1 left ankle and left lower leg were observed on or around April 7, 2021. Staff interviews revealed that R1 was not repositioned as instructed every two hours or as needed. Specifically, staff reported that R1 was repositioned every two hours during the day and one to three times during the night. However, staff also reported that if R1 was asleep staff did not “bother” R1 with repositioning or changing incontinent brief. R1 was noted to be unable to rotate position independently. Allegation #2 - Staff administered oxygen to resident without physician's order. Investigation was conducted by Department staff. During the course of the investigation, interviews revealed that staff provided R1 with oxygen prescribed to another resident on multiple occasions. Interviews conducted with staff 2 (S2) and staff 3 (S3) confirmed that on April 18, 2021, staff 1 (S1), Administered oxygen from another resident's oxygen supply to R1. Based on the evidence gathered during the investigation the allegation of neglect and oxygen was administered to resident without physician's order. are substantiated. A finding that the complaints are SUBSTANTIATED means that the allegations are valid because the preponderance of evidence standard has been met. In addition, an immediate civil penalty of $500.00 was assessed, per Health and Safety Code 1548 (c). Furthermore, an additional civil penalty may be imposed, per Health and Safety Code 1569.49 (f). No information obtained through interviews or records reviewed indicated a delay in contacting emergency medical services. Based on the information gathered, there is insufficient evidence to support the allegation that staff failed to call 911 in a timely manner. Therefore, the allegation is determined to be UNFOUNDED. This report was reviewed with Facility Administrator Marie Libed and a copy of this report was provided at the conclusion of the visit. Second allegation: Staff did not ensure resident was hydrated. Regarding the allegation stated above, LPA conducted a record review of R1 upon the review of record LPA discovered that an interview with R1 family was conducted by department staff interview indicated that R1 was being well cared for and the family had no concerns regarding the care being provided to R1. LPA conducted interviews with Staff #1 and Staff #2 regarding the allegation stated above and S1 and S2 denied the allegation and informed LPA that R1 was maintained hydrated by staff and fluids to R1 were being provided daily. In addition, S1 and S2 informed LPA that any significant changes to R1 condition or refusals were being communicated to R1 responsible party. Based on corroborating evidence LPA has determined that 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 (LIC 9099) was discussed, and a copy was provided to Facility Administrator Marie Libedthe state’s words, verbatim · CDSS document, Jun 13, 2026 · control 18-AS-20210429134708

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jun 15, 2026

87468.2 .... Additional Personal Rights of Residents in Privately Operated Facilities...(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, 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: Based upon review of facility and other records, observations, and interviews with pertinent individuals, licensee failed to ensure that R1 was provided with care, supervision, and services as needed. As a result, R1 sustained multiple skin and pressure injuries while at facility. This violation posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 13, 2026

Plan of correction: The Licensee has agreed to read over regulation 87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities: and provide training to all staff who provide care to residents. The licensee will also provide LPA with proof of the training signed by all participating staff acknowledging and understanding that Licensee/Staff cannot accept person’s with stage 3 and 4 pressure injuries as they are prohibited health conditions. Plan of correction will be provided on: 6/15/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(A) · Plan of correction due date: Jun 15, 2026

87465 Incidental Medical and Dental Care.... (A) Medications usually prescribed for self-administration which have been authorized by the person's physician. This requirement is not met as evidenced by: Based upon review of facility and other records, observations, and interviews with pertinent individuals, licensee dispensed Oxygen to R1 without a Physician’s order. This violation posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 13, 2026

Plan of correction: The Licensee has agreed to read over regulation 87465(A) Incidental Medical and Dental Care: and provide training to all staff who provide care to residents. The licensee will also provide LPA with proof of the training signed by all participating staff acknowledging and understanding that all medications being administered must be authorized by the resident’s physician. Plan of correction will be provided on: 6/15/2026.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Administrator Marie Antonette Libed. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, of whom one (1) may be bedridden. Hospice waiver for three. During today’s inspection there were four (4) residents in care. LPA with Administrator Libed toured the interior and exterior of the facility and inspected each room. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator Libed, no firearms or ammunition are kept at the facility. Fire extinguisher, carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Administrator Libed to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Apr 10, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrator Marie Antonette Libed and was granted entry to the facility. The facility is a Residential Care Facility for the Elderly (RCFE) licensed capacity six (6) non-ambulatory residents, and approval for one (1) bedridden. Current census is three (3) residents; Two (2) non-ambulatory and one (1) bedridden. The facility is a seven (7) bedroom home with two and-a-half (2.5), bathrooms, kitchen/dining area, living room, and attached garage. LPA was accompanied by Facility Administrator to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to interior and exterior passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperature in the bathrooms to be at 115 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. The postings such as the facility license, personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. The cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident files and staff files. The medications are kept inside a storage cabinet near the kitchen inaccessible to the residents. Food Service: Non-perishable and perishable food supply is sufficient for the residents in care. Record Review: LPA reviewed three (3) residents files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed two (2) staff files for First Aid/CPR certifications, criminal record clearances, training's, and health screenings. During review of record LPA observed fire/and disaster drill was conducted on 12/10/2025. LPA also observed current liability insurance with a renewal date of 7/16/2026. Based on the observations made during today’s visit, no were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Administrator Marie Antonette Libed.the state’s words, verbatim · CDSS document, Jan 7, 2026

Allegation investigated: Staff did not provide a refund upon resident’s death.

On 04/10/2025 at 03:00 PM, Licensing Program Analyst (LPA) Melody Brown met with Licensee/Administrator Marie Libed at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) San Bernardino (SB) Regional Office (RO) to deliver the findings of the above allegation. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of records review and interviews with relevant parties. The investigation was conducted by LPA Melody Brown which consisted of interview with relevant parties and review of records. The allegation indicates staff did not provide a refund upon resident’s death. During the investigation, LPA Brown was not able to obtain sufficient evidence to corroborate the allegation. LPA Brown interviewed Resident # 1 (R1) family member and R1 family member confirmed that they were informed of R1's Admission Agreement indicating "No Refund for Hospice Resident" and they signed it. Interview with Staff #1 (S1) indicated that on 01/31/2025, S1 explained the "No Refund for Hospice Resident" written in R1's Admission Agreement at the facility ***Continuation in LIC9099C*** Unsubstantiated and R1's family member verbalized understanding and signed R1's Admission Agreement. Records Review revealed that R1's Admission Agreement indicated “No Refund for Hospice Resident" and R1 family member and S1 both signed it on 01/31/2025 when R1 moved-in at the facility. Therefore, based on the evidence obtained during LPA Brown's investigation, there is insufficient evidence to prove staff did not provide a refund upon resident’s death is UNSUBSTANTIATED at this time. Although the allegation of staff did not provide a refund upon resident’s death may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time. An exit interview was conducted where this report (LIC9099), was discussed and provided to Licensee/Administrator Marie Libed.the state’s words, verbatim · CDSS document, Apr 10, 2025 · control 56-AS-20250402104857

Type of visit: Case Management - Deficiencies

On 04/02/2025 at 02:15 PM, Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to commence a Case Management - Deficiency. LPA was greeted and granted entry by Staff #2 (S2). LPA Brown explained the purpose of the visit to S2. Licensee/Administrator Marie Libed was contacted and informed of the visit. Licensee/Administrator contacted LPA Brown and LPA identified herself and discussed the purpose of the visit with Licensee/Administrator Libed. Licensee/Administrator Libed designated staff Estelita Mallari Sambrano to sign and receive the report. During the facility visit today, 04/02/2025, LPA Brown unable to obtain Resident #1 (R1) facility records as R1's records were not at the facility and unavailable for review. LPA Brown informed staff Sambrano that deficiency will be issued. An exit interview was conducted where this report (LIC809), LIC809D and Appeal Rights were discussed and provided to staff Estelita Mallari Sambrano.the state’s words, verbatim · CDSS document, Apr 2, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(e) · Plan of correction due date: Apr 7, 2025

87506 Resident Records (e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident. This requirement is not met as evidenced by: Based on observation, and interview, the Licensee did not comply with the section cited above by not ensuring that Resident #1 (R1) records were retained for a minimum of three (3) years following termination of service and available for review which poses a potentisl health, safety, or personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Apr 2, 2025

Plan of correction: Licensee stated to provide LPA Brown copies of R1's records by the Plan of Correction (POC) due date. Licensee stated to submit Signed Statement of Understanding on CCR 87506(e) to LPA Brown by the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrator Marie Antonette Libed and was granted entry to the facility. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for a capacity of six (6) non-ambulatory residents, one (1) resident may be bedridden. The current census is three (3) residents. LPA was accompanied by Administrator to conduct a general overall inspection, which included, but was not limited to, the following: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to interior and exterior passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperature in the bathrooms to be at 108 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. The postings such as the facility license, personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. The cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident files and staff files. The medications are kept inside a storage cabinet near the kitchen inaccessible to the residents. The non-perishable and perishable food supply is sufficient for the residents in care. LPA reviewed three (3) residents files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed two (2) staff files for First Aid/CPR certifications, criminal record clearances, trainings, and health screenings. Based on the observations made during today’s visit, no were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Administrator Marie Antonette Libed.the state’s words, verbatim · CDSS document, Apr 9, 2024