Gold Medal Senior Living Gardens

Allegation investigated: Due to lack of supervision, resident fell and sustained an injury. Staff did not ensure resident's bathroom met the resident's needs.

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 08/08/2026 regarding the above allegations, to deliver findings. On 05/09/2025, LPA Ramirez conducted an initial complaint investigation visit and a need for further investigation was documented. During today’s visit LPA Ramirez was greeted by Caregiver- Adrian Colores and explained the purpose of the visit. LPA Ramirez was provided House Manager- Victoria Serna’s telephone number and was asked to contact Serna to discuss LPA’s visit. The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster, Copy of Resident#1 (R1): Medical Assessment, Identification and Emergency Information, Hospice care plans, staff interviews#1-6 (S1- S6), resident interviews# 1-3 (R1- R3), attempted interview of resident# 4-6 (R4-R6) and physical plant tour. See 9099-C Unsubstantiated The investigation revealed the following: regarding the allegation “Due to lack of supervision, resident fell and sustained an injury.” It is alleged that due to a lack of supervision, R1 fell and sustained a new injury. Six (6) out of the six (6) staff interviewed denied this allegation. Staff interviews revealed that R1 could walk independently with a walker but had several falls the first week R1 arrived at the facility. Staff interviews revealed that staff checked on R1 every 1 to 2 hours, placed a fall mat beside R1’s bed, used a baby monitor to listen for when R1 needed assistance and contacted R1’s hospice care team after each fall. Review of R1’s medical records did not corroborate that R1 sustained a new injury as a result of a fall at the facility. Three (3) out of the three (3) residents interviewed denied this allegation. Resident interviews revealed that staff provides sufficient supervision. Due to cognitive abilities R4-R6 interviews were unreliable. 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 is UNSUBSTANTIATED. “Staff did not ensure resident's bathroom met the resident's needs.” It is alleged staff did not ensure R1’s bathroom met R1’s needs. Six (6) out of the six (6) staff interviewed denied this allegation. Three (3) out of the three (3) residents interviewed denied this allegation. On 05/09/2025, LPA Ramirez interviewed R1 and demonstrated to LPA how R1 gains entry into their private bathroom. LPA observed R1 use their walker to walk into their private bathroom without difficulty. LPA Ramirez observed grab bars near R1 toilet and near the shower. 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 is UNSUBSTANTIATED. Exit interview was conducted. No deficiencies were cited during this visit. A copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 8, 2026 · control 28-AS-20250502102030

Allegation investigated: Due to lack of supervision, resident fell and sustained an injury. Staff did not ensure resident's bathroom met the resident's needs.

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 08/08/2026 regarding the above allegations, to deliver findings. On 05/09/2025, LPA Ramirez conducted an initial complaint investigation visit and a need for further investigation was documented. During today’s visit LPA Ramirez was greeted by Caregiver- Adrian Colores and explained the purpose of the visit. LPA Ramirez was provided House Manager- Victoria Serna’s telephone number and was asked to contact Serna to discuss LPA’s visit. The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster, Copy of Resident#1 (R1): Medical Assessment, Identification and Emergency Information, Hospice care plans, staff interviews#1-6 (S1- S6), resident interviews# 1-3 (R1- R3), attempted interview of resident# 4-6 (R4-R6) and physical plant tour. See 9099-C Unsubstantiated The investigation revealed the following: regarding the allegation “Due to lack of supervision, resident fell and sustained an injury.” It is alleged that due to a lack of supervision, R1 fell and sustained a new injury. Six (6) out of the six (6) staff interviewed denied this allegation. Staff interviews revealed that R1 could walk independently with a walker but had several falls the first week R1 arrived at the facility. Staff interviews revealed that staff checked on R1 every 1 to 2 hours, placed a fall mat beside R1’s bed, used a baby monitor to listen for when R1 needed assistance and contacted R1’s hospice care team after each fall. Review of R1’s medical records did not corroborate that R1 sustained a new injury as a result of a fall at the facility. Three (3) out of the three (3) residents interviewed denied this allegation. Resident interviews revealed that staff provides sufficient supervision. Due to cognitive abilities R4-R6 interviews were unreliable. 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 is UNSUBSTANTIATED. “Staff did not ensure resident's bathroom met the resident's needs.” It is alleged staff did not ensure R1’s bathroom met R1’s needs. Six (6) out of the six (6) staff interviewed denied this allegation. Three (3) out of the three (3) residents interviewed denied this allegation. On 05/09/2025, LPA Ramirez interviewed R1 and demonstrated to LPA how R1 gains entry into their private bathroom. LPA observed R1 use their walker to walk into their private bathroom without difficulty. LPA Ramirez observed grab bars near R1 toilet and near the shower. 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 is UNSUBSTANTIATED. Exit interview was conducted. No deficiencies were cited during this visit. A copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 8, 2026 · control 28-AS-20250502102030

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual inspection using the Compliance and Regulatory Enforcement (CARE) Tool. Upon arrival, LPA was greeted by Joanna Castellanos and explained the purpose of the visit. Care Manager Victoria Serna arrived shortly thereafter. The facility is licensed to provide care and supervision to six (6) residents, age 60 and older. The approved capacity includes up to four (4) non-ambulatory residents and one (1) bedridden resident. 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. Physical Plant The facility is located in a residential neighborhood and is a single-story home consisting of five (5) resident bedrooms, three (3) bathrooms (including one private resident bathroom and one staff bathroom), a living room, kitchen, dining area, laundry room, garage, front yard, and backyard. LPA observed all five (5) resident bedrooms, which were equipped with the required furnishings, including a bed, mattress, linens, dresser, chair, and adequate lighting. During the inspection, LPA observed cleaning supplies and toxic substances stored in the kitchen cabinet beneath the sink that were accessible to residents as current lock was broken. A deficiency was cited. The bathrooms were clean and equipped with the required grab bars near the toilets and in the shower areas, as well as non-skid mats. Hot water temperature measured within the required range of 105°F to 120°F. An adequate supply of extra linens and towels was available in a hallway cabinet. Smoke and carbon monoxide detectors were tested and found to be operational. Fire extinguishers were observed throughout the facility and were readily accessible. No bodies of water were present on the premises. The backyard contained shaded seating areas for resident use. All passageways, walkways, and exits were observed to be clear, unobstructed, and free of hazards. (continued on 809C) Food Service Refrigerators/freezers were maintained at proper temperatures (refrigerators maximum of 40 degrees °F and freezer 0-degree °C) with sufficient supply of 2-day perishable and 7 days non-perishable food. Fresh produce, proteins, and dry goods were stocked. Knives and were observed in a locked kitchen drawer. Health-Related Services & Records Three (3) resident files were reviewed. All files contained Admission Agreements, Pre-Placement Appraisals, Consents, Rights Acknowledgments, Re- Appraisals and current TB screening documentation. However, Resident 1 (R1)'s file did not contain an exception on file authorizing the use of full bed rails. Additionally, Resident 3 (R3) and Resident 4 (R4) did not have physician's orders authorizing the use of half bed rails. A deficiency will be cited for failure to maintain the required physician's orders in the resident records. Three (3) residents' medications were reviewed. No concerns were identified during the medication review. Medications were observed to be centrally stored. Medication Administration Records (MARs) were reviewed and found to be current and accurately maintained. Disaster Preparedness The last documented fire and earthquake drill was conducted on April 23, 2026, and drill logs were available for review. The LIC 610D Emergency Disaster Plan was posted near the entrance of the home. Emergency disaster supplies were observed to be available. The facility's Infection Control Plan was current and available for review. Personnel Records & Training Three (3) staff files were reviewed. All three (3) files contained documentation of criminal record clearances, current CPR/First Aid certifications, required annual training, and current TB screenings. Insurance Liability insurance was in compliance with an expiration date of July 22, 2026. An exit interview was conducted with Victoria Serna,Care Manager. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C, and appeal rights will be providedthe state’s words, verbatim · CDSS document, Jun 26, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted the required annual inspection. LPA Ramirez identified herself and was greeted by Rosalina Gonzalez. Care Manager Victora Serna arrived within the hour. This facility is licensed to serve six (6) residents over the age of 59, of which four (4) may be non-ambulatory in bedrooms# 2,3,4,5; and (1) may be bedridden in bedroom#3. This facility may retain no more than six (6) hospice residents. There was one (1) resident under hospice care during the time of inspection. LPA Ramirez observed three (3) staff providing care and supervision during inspection. 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 in the living room and smoke alarms in hallways. LPA Ramirez inspected five (5) resident rooms. All resident bedrooms contained the required furniture, linens and lighting. LPA Ramirez observed postings encouraging proper hand washing etiquette in restrooms. LPA Ramirez observed grab bars near toilets. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. SEE 809-C Food Service: LPA Ramirez observed a sufficient supply of nonperishable foods 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 sufficient space to accommodate indoor and outdoor activities. LPA Ramirez observed staff and resident engaging in cognitive abilities games during inspection. 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 the facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D) in place. The last documented emergency drills were conducted on 06/23/2025 & 05/4/2025. LPA Ramirez observed facility sketches with exits and emergency exits routes upon entrance of facility. LPA Ramirez observed emergency food supply in laundry room. The emergency water supply was in the garage. Residents with Special Needs: No large bodies of water were observed. LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” was observed. 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: Medications are centrally stored in medications cart and in bubble packs and/or original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. The facility provides incidental medical services. Staffing: Administrator Certificate for Tony Santos expires 02/20/2026. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Infection Control: There 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. SEE 809-C Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed CPR and First Aid for two (2) out of the two (2) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for two (2) out of the two (2) personnel records reviewed. LPA Ramirez did not observe documentation of required annual training in personnel files. During the annual inspection on 6/16/2024, LPA Ramirez issued a Technical Violation based on this observation and advised Care Manager Serna on the importance of maintaining documentation of staff training in personnel records. LPA Ramirez will now issue a Type B deficiency for lack of compliance with regulation 87411(c)(6). Resident Records/Incident Reports: LPA reviewed Resident files for Resident #1 (R-1) through Resident #6 (R-6). Resident files 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. Operational Requirements: This facility is licensed to serve six (6) residents over the age of 59, of which four (4) may be non-ambulatory in bedrooms# 2,3,4,5; and (1) may be bedridden in bedroom#3. During record review, LPA Ramirez observed six (6) out of six (6) physician reports revealed all six (6) residents were non-ambulatory. On 8/4/25, around 7:30am, prior to LPA’s arrival; one (1) of the six (6) residents passed away while on hospice care. LPA Ramirez will issue one (1) Technical Advisory based on this record review. LPA Ramirez spoke with Administrator Santos over the telephone and advised her on the facility’s responsibility to follow their approved fire clearance. This facility may retain no more than six (6) hospice residents. There is one (1) resident under hospice care. One (1) deficiency was observed during inspection and one (1) Technical Advisory was issued. Exit interview was conducted. A copy of this report, 809-D, LIC 9102, and appeals rights were provided.the state’s words, verbatim · CDSS document, Aug 4, 2025

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: Staff did not ensure that resident was adequately fed Staff did not ensure that resident had a call button that was operable Staff mismanaged resident medication Staff do not respond to resident's call for assistance in a timely manner

Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with House Manager Victoria Serna and explained the purpose of the visit. The investigation consisted of the following: During the initial visit conducted on 06/10/2025, LPA interviewed Administrator, Staff #1- Staff #3, Residents #1 -Residents #3, checked food supply, check that call buttons were working, and checked R1’s medication for any errors or discrepancies. LPA obtained copies of the following documents: Staff roster, Resident roster, R1’s Physicians report, identification and emergency information, and emails between staff and POA for R1. During today’s visit LPA Gutierrez delivered findings. SEE 9099C Unsubstantiated In regard to the allegation “Staff did not ensure that resident was adequately fed”, it is alleged that staff is not feeding residents a balanced nutritional meal. During interviews with Administrator and staff four (4) out of four (4) staff stated that all residents are always fed nutritional meals with fresh fruits and vegetables. Administrator stated that some family’s advise facility what their family member can and cannot eat. During interviews with residents three (3) out of three (3) residents stated that food is okay and that they are fed enough LPA did a tour of food supply and there was a sufficient supply of 2-day perishable foods and 7 day non-perishable foods with a variety of fresh fruits such as strawberry’s, grapes, watermelon, oranges, fresh vegetables such as lettuce, carrots celery and bell peppers, and whole grains. In regard to the allegation “Staff did not ensure that resident had a call button that was operable”, It is alleged that R1’ s call button was taken away for pushing it to many times and that when POA came and pushed button it did not work”, During interviews with Administrator and staff four (4) out of four (4) staff stated call button was never taken away from R1 and that staff had informed R1”s POA that resident had a hard night and call button was pressed repeatedly. Staff also stated that R1 has a call button in bedroom restroom and a call alarm on seat recliner. S1 stated that batteries may have died and were changed immediately. During interviews with residents two (2) out of three (3) stated that call buttons work, and staff responds when called. R3 did not have a call button. LPA tested residents call buttons and both were working at time of visit. In regard to the allegation “Staff mismanaged resident medication”, it is alleged that a Tylenol pill was found on floor of R1’s bedroom floor. During interviews with Administrator and staff four (4) out of four (4) stated they pass out medication to residents and ensure that they are taken. Staff did state that R1 sometimes refuses medication but does not know how pill was on floor. During interviews with residents three (3) out of three (3) stated that they have never had any medication problems with staff. R1 stated “I’m not a baby” when asked if staff watched when he/she took medication. LPA conducted a medication check and found no discrepancies. Facility uses a house supply of Tylenol. SEE 9099C In regard to the allegation “Staff do not respond to resident's call for assistance in a timely manner “, it is alleged that when POA pressed call button nobody came 15 minutes later button was pressed again and no response. During interviews with Administrator and staff four (4) out of four (4) stated that R1 had been pressing call button repeatedly through the night and that might have caused button batteries to die. Staff stated that as soon as it was brough to their attention batteries were changed. During interviews with residents two (2) out of three (3) residents stated that staff responds when they press there call button. R2 stated that they rely on their call button too much. R3 does not use a call button. Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. 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. An exit interview was conducted, and a copy of this report was given to House Manager Victoria Serna.the state’s words, verbatim · CDSS document, Jun 19, 2025 · control 28-AS-20250603185335

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kimberly Ramirez conducted a unannounced Case Management Visit-Deficiency on 05/09/2025, stemming from initial complaint investigation (28-AS-2025052102030) visit on 05/09/2025. LPA was greeted by Administrator Toni Santos and explained the purpose of the visit. Case Management findings: On 05/09/2025, LPA Ramirez reviewed (R1) resident file and observed six (6) Unusual Incident/Injury Reports (LIC 624) from 02/01/2025 through 03/19/2025. These reports revealed R1 had multiple falls and sustained a small skin tear on their elbow. Per Title 22, Division 6, chapter 8, Article 04. 87211(a)(1)(D)- Reporting Requirements- (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (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 report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This licensing agency did not receive these reports. Staff interviews revealed staff did not send these reports to licensing. This poses a potential risk to the health, safety, or personal rights of persons in care. LPA Ramirez will issue a deficiency based on this observation and staff interviews. See 809-C During facility tour, LPA Ramirez observed two (2) unsecured non-portable oxygen tanks in R1’s room. Tanks were observed to not be secured in a stand or secured to the wall. This poses a potential risk to the health, safety, or personal rights of persons in care. Per Title 22, Division 6, Chapter 8, Article 11, 87618(b)(3)(E)- Oxygen Administration- Gas & Liquid- (b) In addition to Section 87611(b), the licensee shall be responsible for the following: (3) Ensuring that the use of oxygen equipment meets the following requirements: (E) Oxygen tanks that are not portable shall be secured in a stand or to the wall. LPA Ramirez will issue a deficiency based on this observation. Two (2) deficiencies were cited for this visit. Exit interview was conducted. A copy of this report, 809-D and appeals rights was provided via email.the state’s words, verbatim · CDSS document, May 9, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: May 16, 2025

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, the following: (1) A written report shall be submitted to the licensing agency within seven days of the occurrence of any of the events in (A) through (D). This report shall include resident's name, date, nature of event; findings,treatment, if any.(D) Any incident which threatens the welfare, safety or health of any resident. This requirement was not met: Staff did not send these reports to LPA. This poses a potential risk to the health, safety, or personal rights of persons in care.the state’s words, verbatim · CDSS document, May 9, 2025

Plan of correction: Licensee agreed to conduct re-training on this regulation by 05/16/2025 and send proof via email to LPA Ramirez.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87618(b)(3)(E) · Plan of correction due date: May 16, 2025

(b) In addition to Section 87611(b), the licensee shall be responsible for the following: (3) Ensuring that the use of oxygen equipment meets the following requirements: (E) Oxygen tanks that are not portable shall be secured in a stand or to the wall. This requirement was not met: 2 oxygen tanks were observed to not be secured to a wall or in a stand. This poses a potential risk to the health, safety, or personal rights of persons in care.the state’s words, verbatim · CDSS document, May 9, 2025

Plan of correction: Licensee agreed to conduct re-training on this regulation by 05/16/2025 and send proof via email to LPA Ramirez. Licensee agreed to contact R1's hospice company to obtain oxygen tank stands by 5/16/25.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted required annual inspection. LPA met with Caregiver Priscilla Serna and explained the purpose of today’s visit. Care Manager Victora Serna arrived within the hour. This facility is licensed to serve six (6) residents over the age of 59, of which six (6) may be non-ambulatory; (1) may be bedridden. This facility may retain no more than six (6) hospice residents. There is one (1) resident under hospice care. LPA Ramirez observed four (4) staff providing care and supervision during inspection. 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 accessible to residents in laundry room. LPA Ramirez observed disinfectants and cleaning solutions located in cabinet above washer and dryer, to be accessible to five (5) out of the six (6) residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected five (5) resident rooms. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be above 120 degrees F. Water temperature in bathroom#1 was measured at 124 degress F, bathroom#2- 122.2 degrees F, and bathroom#3- 123.6 degrees F. LPA Ramirez observe postings encouraging proper handwashing etiquette in restrooms. LPA Ramirez observed grab bars near toilets. LPA Ramirez will issue two (2) Type A deficiencies based on observations. Food Service: LPA Ramirez observed sufficient supply of nonperishable 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 sufficient space to accommodate indoor and outdoor activities. LPA Ramirez observed staff and resident engaging in cognitive abilities game during inspection. 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. SEE 809-C for continuation. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D) in place. Last documented emergency drills were conducted on 05/24/2024. LPA Ramirez observed facility sketches with exits and emergency exits routes upon entrance of facility. LPA Ramirez observed emergency food supply in laundry room. Emergency water supply was located in garage. Residents with Special Needs: No large bodies of water were observed. LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” was observed. 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: Medications are centrally stored in medications cart and in bubble packs and/or original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. The facility provides incidental medical services. Six (6) MAR records were compared to medications stored. Staffing: Administrator Certificate for Tony Santos and expires 02/19/2024. LPA Ramirez observed Administrator’s Certificate for Victoria Santos and expires 08/24/2025. 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 CPR and First Aid for four (4) out of the four (4) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for four (4) out of the four (4) personnel records reviewed. LPA Ramirez did not observe required initial/annual training in personnel files. Care Manager Serna agreed to print completed training and place in personnel files. LPA Ramirez will issue Technical Violation. Infection Control: There 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 fire clearance is approved for six (6) non-ambulatory residents, of which one (1) may be bedridden. This facility may retain no more than six (6) hospice residents. There is one (1) resident under hospice care. Resident Records/Incident Reports: LPA reviewed Resident files for Resident #1 (R-1) through Resident #6 (R-6). Resident files 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. R5 did not have required annual medical assessment. LPA Ramirez will issue Type B deficiency based on record review. Three (3) deficiencies were observed during inspection. Exit interview was conducted. A copy of this report, 809-D and appeals rights was provided.the state’s words, verbatim · CDSS document, Jun 16, 2024

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.