Genesis Manor II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Rudy Trinidad and explained the reason for the visit. Administrator Alaina Hendricks arrived shortly thereafter. This home is licensed to serve 6 residents ages range 60 and over, six (6) non-ambulatory and the facility is approved to accept/retain four (4) hospice residents. There was (3) resident under hospice care during inspection and one (1) on home health. Facility Tour & Observations: Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present. Oxygen signages were observed throughout the facility. Physical Plant The facility is located in a residential area and is a one-story home consisting of four (4) resident bedrooms, two (2) bathrooms (one of which is a private restroom), three (3) caregiver sleeping areas located in and near the garage area, a living room, kitchen, dining area, attached garage, front yard, and backyard. LPA observed all four (4) resident bedrooms, which contained the required furnishings, including a bed, mattress, linens, dresser, chair, and adequate lighting. Hoyer lifts were available in resident rooms to assist with mobility and transfers. Cleaning supplies and toxic substances were stored in a locked area in the garage and were inaccessible to residents. Bathrooms were clean and equipped with required grab bars in the showers and near toilets, as well as non-skid mats. Hot water temperatures were measured at 113.9°F in bathroom (1) and 110.2°F in bathroom (2), which are within the required regulatory range of 105°F to 120°F. Extra linens and towels were available in hallway cabinets. Smoke and carbon monoxide detectors were tested and found to be functional. A fire extinguisher was observed near the front entrance. No bodies of water were present on the premises. The backyard provided shaded seating for residents. Passageways and exits were observed to be clear and unobstructed. **continued on 809C** Food Service Refrigerators and freezers were maintained at proper temperatures (refrigerators at or below 40°F and freezers at 0°F) and contained a sufficient supply of at least two (2) days of perishable food and seven (7) days of non-perishable food. Fresh produce, proteins, and dry goods were adequately stocked. Knives were observed to be stored in a locked kitchen drawer. Health-Related Services & Records Four (4) residents files were reviewed and contained current required documents Admissions Agreements, Pre-Placement Appraisals, Consents, Needs/Service Plans, Physician’s Reports with TB/ambulatory status and Rights acknowledgments. Three (3) residents’ medications were reviewed; medications were observed to be centrally stored in hallway closet. Disaster Preparedness Last fire/earthquake drill was conducted in April 01, 2026, with logs available. LIC 610D Emergency Disaster Plan was available and updated. Emergency supplies (water, food, flashlights, batteries, first aid) were observed. Infection Control Plan was updated. Personnel Records & Training Three (3) staff files were reviewed and included criminal record clearances, CPR/First Aid, required training and TB screenings. Administrator Certificate for Alaina Hendricks was valid through July 18, 2026. Insurance Liability insurance was in compliance with an expiration date of June 15, 2026. An exit interview was conducted with the Administrator Alaina Hendricks. During the inspection, the facility was observed to be following Title 22, Division 6 regulations. No deficiencies were cited at this time. A copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 7, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an annual inspection visit on 04/28/2025 and was greeted by Administrator Alaina Hendrick. LPA Ramirez identified herself and explained the purpose of the visit. The facility is located on a residential street and is a single store dwelling. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected three (3) resident rooms. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside shower. LPA Ramirez observed no-slip coating in showers. LPA Ramirez observed seated shower chairs in bathrooms. LPA Ramirez observed video surveillance in common areas inside the facility. Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 04/19/2025 and 01/13/2025. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed emergency food supply located in garage. See 809-C Residents with Special Needs: No large bodies of water were observed LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication closet and in bubble packs and/or original containers. LPA Ramirez observed Centrally Stored Medication and Destruction Record. The facility provides incidental medical services. Staffing: Administrator Certificate for Alaina Hendrick 07/18/2026. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for three (3) out of the three (3) personnel record reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for three (3) out of the three (3) personnel record reviewed. Infection Control: Staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The facility is licensed to serve six (6) non-ambulatory residents over the age of 60 and provides care for elderly residents with dementia and is approved to retain four (4) residents on hospice. Currently the facility has three (3) residents on hospice care. Resident Records/Incident Reports: LPA reviewed resident records for three (3) residents in care. Resident records are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. No deficiencies were observed during this visit. Exit interview conducted. A copy of this report was provided via email.the state’s words, verbatim · CDSS document, Apr 28, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required 1-year Visit on 03/29/2024. LPA was met by Administrator Alaina Hendrick and explained the purpose of the visit. Back up Administrator Elyssa Markie arrived shortly after to assist with the tour. The facility is licensed to serve six (6) non-ambulatory residents over the age of 60 and provides care for elderly residents with dementia and is approved to retain four (4) residents on hospice. Currently the facility has three (3) residents on hospice care. LPA OBSERVATIONS: The facility is a single-story building located in a residential neighborhood with three (3) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, kitchen, dining room, living room, front yard, backyard, and attached garage. Front Yard: Was clean and well maintained. No hazards were observed. Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to five (5) out of five (5) residents in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in kitchen cabinet, to be inaccessible to five (5) out of five (5) residents in care. Kitchen sink water temperature was measured at 109.9 degrees F. Kitchen appliances were observed to be clean and in working order. Dining Room/Living room/: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed to have plenty of seating and lighting. Linen Closet: Contained plenty linens, towels, and hygiene products. Resident Rooms 1 - 3: LPA Ramirez observed all three (3) resident bedrooms to contain required furnishings, lighting, and linens. All bedrooms are shared. Bathrooms: Water temperature in two (2) resident bathrooms were within 105- 120 degrees F. Bathrooms were observed to be clean and well stocked. see 809-C for continuation. Centrally Stored Medications: Was observed to inaccessible to five (5) out of five (5) residents in care. Medications are stored in facility hallway. Backyard: Was clean and well maintained. No hazards were observed. Plenty of shade and seating was observed. Emergency Drills: Last documented drills were conducted on 01/04/24 and 10/08/23. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. Personnel Records: Personnel records are maintained at facility. LPA Ramirez reviewed staff files for three (3) staff. LPA Ramirez observed Administrator’s certificate for Alania Hendrick with an expiration date of 07/18/2024. First Aid & CPR Certificate, Fingerprint Clearance/ Exemptions, Personnel Record/Job Application, Health Screening, Employee Rights, TB Test, and Initial/Annual Training Verification including HCBS (Home & Community Based Services) Final Rule Training were observed. Resident Files: Five (5) resident files were reviewed. Admissions Agreement, Medical Assessment, Consent Forms, Appraisal and Needs and Services plan, I.D and Emergency Information, TB Test, Centrally Stored Medication Record, and Personal Rights Form were observed. Liability Insurance & Infection Control Plan: Facility has current liability insurance on file. LPA Ramirez observed updated infection control plan. Attached Garage: LPA Ramirez observed emergency water and food supply in this area. Access to garage was observed to be inaccessible to five (5) out of five (5) residents in care. No deficiencies are being cited. Exit interview was conducted with back up Administrator Elyssa Markie and a copy of this report and appeals rights was provided.the state’s words, verbatim · CDSS document, Mar 29, 2024

Allegation investigated: Resident in care sustained pressure injury due to staff's neglect. Staff did not ensure resident's wound care needs were properly met. Staff prevented home health agency staff from performing their duties. Uncleared staff allowed to work in the facility. Facility did not have a qualified administrator.

Licensing Program Analyst (LPA) V. Maldonado made an unannounced subsequent visit to the facility for the purpose of continuing the investigation regarding the above-mentioned allegations, and to deliver findings. LPA Maldonado met with Administrator, Alaina Hendrick, and explained the purpose for the visit. On 10/05/2023, LPA Maldonado made an initial visit at the facility for the purpose of conducting a health and safety inspection. During the visit, LPA obtained a copy of the resident/staff rosters, conducted a tour of physical plant and common areas with staff Elyssa Markie, and obtained the following documents for Residents# 1-6 (R1-R6): Facesheet, Physician's Report, Needs and Services Plan, and Hospice Care Plans. LPA observed food supplies, resident rooms, and observed the residents to identify any signs of neglect, abuse, or other immediate health and safety threats. LPA did not observe any immediate health and/or safety concerns during the visit. During the visit, LPA discovered that all listed staff on the facility roster are currently associated, and current Administrator Certificate# 6015601740 for Alaina Hendrick is available and posted with expiration date of: 07/18/2024. (Report continued on LIC9099-C...) Unsubstantiated The following allegations were assigned to be investigated by the licensing agency's Investigation Bureau (IB) investigator, Heydi Bendana: 1.) Resident in care sustained pressure injury due to staff's neglect. 2.) Staff did not ensure resident's wound care needs were properly met. Investigator Bendana's investigation consisted of the following: Interviews conducted with Administrator Alaina Hendrick (S1), Staff #2-3 (S2-S3), Witnesses #1-4 (W1-W4), which consists of Resident#1's (R1) responsible party (W1), hospice physician (W2), primary care physician (W3), and home health case worker (W4). Investigator Bendana also attempted to interview residents, but was unable to due to cognitive impairment. The following documents for R1 were also reviewed: facility file/documentation including hospice care plan and relevant documents, wound progress reports dated: 9/21/23, 9/28/23,10/12/23, and 10/19/23. The investigation revealed the following: Regarding allegation: Resident in care sustained pressure injury due to staff's neglect. It is alleged that due to staff neglect, R1 sustained a Stage 2 pressure wound, which quickly deteriorated and turned to a Stage 4 pressure wound, and R1's bone became visible. Per hospice and home health records obtained by Investigator Bendana, it was discovered that R1 was admitted to the facility on home health services due to pressure wounds, and was receiving services to provide wound care. Per Investigator Bendana's interviews conducted, (3) of (3) staff denied neglecting R1's care resulting in a pressure wound rapidly deteriorating. Staff stated that S1 sought better care for R1 when they noted R1's wounds were not healing properly due to the care provided from the initial home health agency that was providing care. Per witness interviews, (4) of (4) witnesses denied the facility neglecting the resident's care resulting in a pressure wound deteriorating. Per W2, due to the resident's current health condition, it was "almost impossible" to prevent R1 from to sustaining pressure wounds, regardless of how well the wounds were being cared for and how often R1 was being repositioned. Per W4, hospice staff reported to W4 that facility staff were providing "excellent care" to R1. Per R1's hospice care plan, R1 required frequent repositioning to assist in the healing of the pressure wounds and there is no indication that the pressure wounds ever deteriorated to a stage 4. Therefore, this allegation is Unsubstantiated. Regarding allegation: Staff did not ensure resident's wound care needs were properly met. It is alleged that facility staff did not meet R1's wound care needs, while R1 presented with stage 2 pressure wounds, which quickly deteriorated and resulted in stage 4 pressure wounds. (Report continued on LIC9099-C...) Per investigator Bendana’s interviews conducted, (3) of (3) staff denied not meeting R1's wound care needs. Staff stated that they repositioned R1 frequently as noted in R1’s care plan and followed R1’s wound care plan. They also stated that S1 sought better care for R1 when they noted R1's wounds were not healing properly due to the care provided from the initial home health agency that was providing care. Per witness interviews, (4) of (4) witnesses denied the facility staff not meeting the resident's wound care needs. Per W2, due to the resident's current health condition, it was "almost impossible" to prevent R1 from to sustaining pressure wounds, regardless of how well the wounds were being cared for and how often R1 was being repositioned. Per W4, hospice staff reported to W4 that facility staff were providing "excellent care" to R1. Therefore, this allegation is Unsubstantiated. During today's visit, LPA Maldonado, continued the investigation regarding the following allegations: 4. Staff prevented home health agency staff from performing their duties. 5. Uncleared staff allowed to work in the facility. 6. Facility did not have a qualified administrator. LPA also obtained personnel records for Administrator, Alaina Hendrick, and conducted interviews with Staff#1-6 (S1-S6), and Home Health LVN (LVN). LPA attempted to interview Residents#1-5 (R1-R5), but was unable to due to cognitive impairment. The investigation revealed the following: Regarding allegation: Staff prevented home health agency staff from performing their duties. It is alleged that a facility staff, who is not the administrator of the facility, informed a home health agency that they were not allowed to go to any of their licensed facilities- disrupting the care of residents who reside in this home. (6) of (6) staff interviewed denied the allegation, stating that home health has never been denied entry to this facility, to provide the services needed. Per interview with LVN, staff of this facility never denied home health entry to this facility, to provide services to a resident. (5) of (5) residents could not corroborate the allegation. Therefore, this allegation is Unsubstantiated. Regarding allegation: Uncleared staff allowed to work in the facility. It is alleged that a home health LVN was allowed to work at the facility without appropriate criminal background clearance and association to the facility. (Report Continued on LIC9099-C...) After review of the Facility Personnel Report Summary and the Staff Roster, it was noted that all staff have appropriate criminal background clearance and are associated to the facility. (6) of (6) staff interviewed denied the allegation and stated that LVN never worked at the facility as facility staff. LVN only provided home health services to residents. Staff also stated that new employees are fingerprint cleared and associated prior to working at the facility. (5) of (5) residents could not corroborate the allegation. Per interview with LVN, the allegation was denied and LVN stated to have never been employed as facility staff by the Licensee. Regarding allegation: Facility did not have a qualified administrator. It is alleged that a home health agency's LVN was allowed to work as an interim administrator for this facility, without having appropriate certification. (6) of (6) staff interviewed denied the allegation and stated that LVN has never worked as a staff or administrator for this facility. (5) of (5) residents interviewed could not corroborate the allegation. Per interview with LVN, the allegation was denied. LVN stated that LVN has never been employed by the facility Licensee and has never worked as a staff/administrator for this facility. Per staff roster and Facility Personnel Report, LVN is not listed as a staff at this facility and is not associated. After review of Administrator personnel records, Alaina Hendrick is the listed Administrator for this facility with Certificate# 6015601740 expiration date: 07/18/24 and has met the appropriate qualifications for Administrator. Based on LPA's observations, records review, and interviews held: 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, therefore the allegations are Unsubstantiated. Per California Code of Regulations, Title 22, no deficiencies were observed or cited. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 14, 2024 · control 28-AS-20231004142452