Gold Quartz Inn Retirement Home

Allegation investigated: Staff are not following proper infection control protocols with residents in care. Facility is not reporting infectious conditions as required.

On 08/04/26, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to open an investigation into the above allegations. LPA identified herself upon arrival, stated the purpose of the visit, and asked to meet with the Designated Facility Administrator. LPA met with Executive Director (ED) Loreen Hickman and a brief interview followed. LPA requested the following documents: Staff roster for all care staff, medication technicians, and housekeeping Schedules for May, June, and July 2026 Medical reports/test results, and Medication Records for R1 and R2 for June and July 2026 LPA reviewed medical documents for Resident R1. On 05/12/26, a home health nurse reported that R1 had a rash and suspected scabies. The ED stated that the home health nurse reported this information to the doctor and an appointment was made for R1 with a dermatologist on 05/21/26. During that visit, Substantiated a specific diagnosis was not determined and a biopsy was conducted. LPA reviewed the biopsy report dated 05/21/26 which still did not confirm or rule out a diagnosis of scabies. LPA reviewed the Electronic Medication Administration Record for R1 and learned the following. R1 was treated with Ivermectin and Permethrin on 05/29/26 and again on 06/05/26. The ED stated that an incident was not sent to Community Care Licensing (CCL) regarding the possible diagnosis and treatment for scabies. They also stated that although they notified R1's responsible party regarding R1 potentially having scabies. LPA contacted the the responsible party who they were not notified. R1 had been complaining about the rash they had, and their responsible party called to make the appointment with a dermatologist. Home health initially reported their suspicions for R1 potentially having scabies on 05/12/26 and they were not quarantined and kept separate from other residents in care. The ED stated that they thought the home health nurse would contact the family and the PCP so the facility did not. R1 did not receive a medical evaluation until 9 days later on 05/21/26 when the responsible party took R1 due to their complaints regarding their rash. The evaluation was inconclusive and a biopsy was performed. The results remained inconclusive - they neither confirmed nor ruled out scabies. R1 was not quarantined. R1 received treatment 8 days later on 05/29/26 and again on 06/05/26. R1 was quarantined from 05/29/26 until 06/02/26. During that time period, R1 was relocated to another room so their room could be deep cleaned. Although it was not confirmed the rash was from something contagious, it still was a possibility and infection protocols should have been implemented. According to the California Code of Regulations, Title 22, the facility is responsible for notifying CCL, the resident's primary care physician, and their responsible party whenever there is a change of condition or an unusual incident. Based on a review of records and interviews with the responsible party and the ED, the department found the allegations, "Staff are not following proper infection control protocols with residents in care," and "Facility is not reporting infectious conditions as required," SUBSTANTIATED. These deficiencies have been cited on the LIC 9099D page. No other deficiencies were observed or cited during today's visit, a copy of this report was provided and an exit interview was conducted with Hickman.the state’s words, verbatim · CDSS document, Aug 4, 2026 · control 27-AS-20260727164010

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87470 · Plan of correction due date: Sep 16, 2026

CCR 87470 Infection Control The above regulation was not met as evidenced by: Based on a review of medical records and interviews with the ED and the responsible party for R1, the facility was aware of a potentially infectious condition and did not implement infection control protocols. This posed a potential threat to the health, safety and personal rights of residents in care.the state’s words, verbatim · CDSS document, Aug 4, 2026

Plan of correction: The ED will be bringing in an outside service to conduct an training on infectious diseases/conditions with all staff. ED will send the agenda with the facilitor's contact information and a signature sheet for all participants.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Aug 31, 2026

(a) Each licensee shall furnish to the licensing...(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days...specified in (A) through (D) below... The above regulation was not met as evidenced by: Based on interviews with the ED and the responsible party for R1, the facility did not send an LIC 624 to CCL, it did not notify the PCP and it did not contact the resposble party for R1. This posed a potential threat to the health, safety and personal rights of residents in care.the state’s words, verbatim · CDSS document, Aug 4, 2026

Plan of correction: ED will have a training on reporting requirements with all staff. ED will send the agenda with the facilitor's contact information and a signature sheet for all participants.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(1) · Plan of correction due date: Aug 31, 2026

87465 Incidental Medical and Dental Care (a)...shall be developed by each ...(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. The above regulation was not met as evideced by: Based on interviews with the ED, the responsible party for R1, and a a review of medical records, the facility waiting 9 days after hone health notified them that R1 might have scabies. This posed a potential threat to the health, safety and personal rights of resdients in care.the state’s words, verbatim · CDSS document, Aug 4, 2026

Allegation investigated: Facility toilet is in disrepair Facility staff did not provide resident's records to authorized representative Facility staff do not safeguard resident's belongings Facility staff not providing a comfortable environment for the resident Facility did not ensure that resident reappraisals were conducted

On 05/28/2026, Licensing Program Analyst (LPA) Pang Lee arrived unannounced at the facility to conduct a complaint visit. LPA Lee met with Assistant Administrator (AA) Brandee Butler and explained the purpose of the visit. The purpose of today’s visit was to deliver the complaint findings regarding the above allegations. Per AA Butler, Administrator Loreen Hickman was off duty today. The current census was 34. A brief interview was conducted with AA Butler. It was alleged that the facility toilets were in disrepair. The investigation included observations and interviews with staff and residents. During LPA Lee’s facility visit on 03/03/2026, LPA Lee inspected nine residents’ toilets, including Resident 1’s (R1) toilet in room 102, and observed that all toilets were in good repair and functioning properly. During LPA Lee’s facility visit on 04/23/2026, LPA Lee inspected five additional residents’ toilets, including R1’s toilet, and again observed that all toilets were in good repair and functioning properly. Unsubstantiated Interviews were conducted with six out of six staff members, all of whom stated that the residents’ toilets were in good repair. Staff members also denied instructing residents to dispose of used toilet paper in trash bins instead of flushing it. Additionally, twelve out of twelve residents interviewed reported that the toilets were not in disrepair. Furthermore, eleven out of eleven residents stated that facility staff had not instructed them to dispose of used toilet paper in trash bins. Based on the investigation, it was further learned that toilets may occasionally clog depending on usage; however, maintenance staff are readily available to address and unclog toilets to restore proper function. Based on the observations and interviews conducted, LPA Lee was unable to corroborate the allegation. It was alleged that facility staff did not provide resident’s records to authorized representatives. The investigation included interviews with the Administrator Hickman and a review of records. On 02/01/2026, it was learned that the resident’s authorized representative requested Resident 1 (R1)’s records, specifically pendant call logs. It was further noted that the facility’s call system retains only 16 pages of call history. On 02/05/2026, the authorized representative requested additional documents, including all communication logs that are posted on R1’s refrigerator. On 02/11/2026, Administrator Hickman explained to the authorized representative the facility’s protocol for releasing records and provided the authorized representative with an Authorization for Use and Disclosure of Protected Health Information form to state that authorized representative can obtain R1’s records. It was also learned that the Power of Attorney documentation that the authorized representative provided to the facility was limited to financial matters and did not include access to medical records. The facility contacted and discussed this matter with the authorized representative. On 02/13/2026, the authorized representative submitted the signed Authorization for Use and Disclosure of Protected Health Information form, and it was learned that the authorized representatives were 4th in line. On 02/16/2026, authorized representative sends signed authorization for use and disclosure of protected health information form. On 02/26/2026, the authorized representative requested additional and all records and documents related to R1’s stay at the facility from date of admission 11/05/2024 to 03/18/2026. On 03/03/2026, all requested documents were collected and taken to the corporate office for copying, and the authorized representative was notified that the copies were ready to pick up. The authorized representative confirmed via email that they would retrieve the documents. Based on the record review, there was ongoing communication between the facility and the authorized representative regarding the requested documents and the requested records were provided to the authorized representative. Therefore, based on the records review and interviews conducted, LPA Lee was unable to corroborate the allegation. CONTINUED LIC 9099-C It was alleged that facility staff do not safeguard residents’ belongings. The investigation included observations and interviews with facility staff and residents in care. During the investigation, it was learned that Resident 1’s (R1’s) pillowcase and mask were not returned after being washed that week. Based on observations made during facility visits conducted on 03/03/2026 and 04/23/2026, LPA Lee observed in the laundry room that residents’ clothing was labeled with their name and initials. Resident bedding and sheets were folded, bagged, and prepared for delivery to residents after laundering. Interviews with six out of six facility staff revealed that residents’ belongings are labeled with the resident’s name and initials, and any unlabeled items were placed in the lost and found area. The laundry area was organized, and a system was in place for processing residents’ laundry. LPA Lee also observed a designated area in room 113 for residents’ lost items, where residents and family members could access and look for unidentified belongings that did not have names labeled on them. Interviews with 12 out of 12 residents indicated that they had no concerns regarding the facility’s laundry services or staff safeguarding residents’ belongings. R1 stated that the pillowcase and mask had been returned and has no concerns anymore. Based on observations and interviews conducted, LPA Lee was unable to corroborate the allegation. It was alleged that facility staff did not provide a comfortable environment for the residents. The investigation included observations and interviews with facility staff and residents. Based on observations made during facility visits conducted on 03/03/2026 and 04/23/2026, LPA Lee did not observe facility staff making residents feel uncomfortable. During both visits, facility staff were observed assisting residents with their activities of daily living (ADLs), and no mistreatment of residents by staff was observed. Interviews conducted with six out of six facility staff revealed that they had not witnessed any staff mistreating residents or making residents feel uncomfortable. Interviews with 10 out of 12 residents indicated that they had no concerns regarding staff not providing a comfortable environment. Additionally, the 10 residents stated that they felt safe living in the facility and had no concerns regarding facility staff. Based on observations and interviews conducted, LPA Lee was unable to corroborate the allegation. It was alleged that the facility did not ensure resident reappraisals were conducted. Based on the investigation, including records review and interviews, it was learned that Resident 1 (R1) moved into the facility on 11/05/2024. A pre-admission questionnaire and LIC 603 Pre-Placement Appraisal were completed on 09/09/2024. CONTINUED LIC 9099-C An Augmented Standard Assessment/Care Plan for R1 was later completed on 01/24/2025 and signed by both Administrator Hickman and R1’s Responsible Party (RP). Additionally, a LIC 625 Appraisal/Needs and Services Plan was completed on 01/21/2026; however, the document was not signed either by either the Administrator Hickman or RP. According to an interview with Administrator Hickman, R1’s RP took the LIC 625 document dated on 01/21/2026 for review and signature but did not return the completed form. Administrator Hickman further stated that the RP provided the facility with a 30-day notice on 02/18/2026, and R1 then moved out of the facility on 03/18/2026; therefore, the form was never returned signed. Based on an interview with the RP, it was confirmed that facility staff did provide them with a document for review and signature. However, the RP stated that R1 was hospitalized at the time, and they did not have the opportunity to review and sign the document and that they could not recall which specific document was provided and were unable to locate the paperwork. Based on the records reviewed and interviews conducted, it could not be confirmed whether the document provided to the RP was the resident’s reappraisal, as the RP was unable to recall which form had been provided; therefore, LPA Lee was unable to corroborate the allegation. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred. An exit interview was conducted with AA Butler, and a copy of the LIC 9099 report was provided to the facility. According to Administrator Hickman, via an email on 05/27/2026, when a resident’s medication entry contains staff initials, it indicates that the medication was administered. If the staff initials are circled, it indicates that the resident refused the medication. Administrator Hickman further stated that if there are no staff initials and the entry is left blank, it means the medication was not administered to the residents. During today’s visit on 05/28/2026, LPA Lee reviewed the 10 dates and times on the QuickMAR that were left blank with AA Butler, and AA Butler acknowledged that there were no staff initials or documented explanations indicating why the medications were not administered to R1 on those dates and times and was not able to provide LPA Lee any reasons. Therefore, based on the blank entries observed in the QuickMAR records, the facility was unable to demonstrate that the medications were administered as prescribed, LPA Lee was able to corroborate the allegation that the facility did not ensure residents received their medications timely. As a result of this investigation, the Department finds the allegation to be SUBSTANTIATED. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted with AA Butler, and a copy of the LIC 9099 reports, LIC 9099-D page, and Appeals rights were provided to the facility.the state’s words, verbatim · CDSS document, May 28, 2026 · control 27-AS-20260226152218

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jun 11, 2026

87465 (a)(4) Incidental Medical and Dental Care (a)A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4)The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interviews and record reviews, the licensee did not comply with the regulation cited. Facility did not ensure medications were administered to R1 as prescribed. This poses immediate health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, May 28, 2026

Plan of correction: AA Butler/facility agrees to conduct staff training regarding medication administration and medication record-keeping by the POC due date 06/11/2026 end of day 5:00 PM. Administrator agrees to email LPA Lee a copy of the training materials used for the training and staff sign-in sheet for attending the training.

Type of visit: Required - 1 Year

On 03/03/2026, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with Executive Director (ED) Loreen Hickman and explained the purpose of the visit. The current census is 34. LPA Lee inspected the physical plant including but not limited to the common areas, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room, facility storage, staff office, activity rooms and medication room to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. LPA Lee inspected nine residents’ toilets and observed that all were in good repair and functioning properly. Hot water temperature was measured in two residents’ bathroom sink and was at 112.4 and 116.1 degrees Fahrenheit which is within the required regulation of 105 to 120 degrees Fahrenheit. The laundry room was also toured. LPA Lee observed residents’ clothing labeled with their initials. Resident bedding and sheets were observed folded and bagged, ready to be delivered to residents after washing and drying. The laundry area was organized, with a system in place for processing residents’ laundry. An area designated for residents’ lost items was also observed. LPA observed facility’s activity calendar posted and sufficient equipment and supplies to meet activity program needs of residents in care. LPA Lee also observed five residents participating in the activity for the day. LPA Lee toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. The facility’s exhaust hood was last serviced on 03/21/2025. The smoke and carbon monoxide detectors are in compliance with fire safety. CONTINUED LIC 809-C The fire extinguisher is located throughout the facility and was last serviced on 11/18/2025. The last fire drill was conducted on 12/03/2025. LPA Lee observed the facility has a has a public telephone in each resident’s room and in the medication room for residents use and the facility has the required posters posted. Facility thermostat was observed at 75 degrees Fahrenheit, which is within the required regulation of 68 to 85 degrees Fahrenheit. LPA Lee observed toxins and sharp knives kept locked and inaccessible to residents. LPA Lee checked medication storage and found medication to be locked away and inaccessible to residents. The first aid kit was checked and contained the required components. LPA Lee, along with the medication technician staff, reviewed five residents’ medications using the facility’s All Care Systems, which logs residents’ medications and documents when medications are administered. A review of the five residents’ medication records was conducted, and no discrepancies were observed. During this inspection, LPA conducted an audit of facility files, five resident files, and three staff files for regulatory compliance and they were complete. The following documents will be emailed to LPA Lee at pang.lee@dss.ca.gov by end of day 03/10/2026: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with ED Hickman and a copy of the LIC 809 reports was provided to the facility.the state’s words, verbatim · CDSS document, Mar 3, 2026

Type of visit: Case Management - Deficiencies

On 2/11/26 Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced Case Management deficiencies inspection to address deficiency observed while conducting a walk through of the facility as part of a complaint investigation. LPA inspected the facility canned goods supply and emergency food supply. LPA observed several dented cans retained for resident consumption that should have been returned to the vendor or disposed as department regulations prohibit the retention of dented canned goods to ensure the food supply is protected from contamination. Per the California Code of Regulations, Title 22, the following deficiency is cited during today's inspection. Exit interview conducted and a copy of this report and appeal rights were provided to the administrator.the state’s words, verbatim · CDSS document, Feb 11, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(8) · Plan of correction due date: Feb 20, 2026

General Food Service Requirements: All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement was not met as evidenced by LPA observations of dented canned goods retained in canned goods supply and emergency food supply which poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 11, 2026

Plan of correction: Administrator agrees to review regulation with dietary and maintenance staff to ensure canned goods are returned to vendor and not retained or used.

Type of visit: Required - 1 Year

On 2/20/25, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced annual required visit, with the use of the CARE Inspection Tool. LPA met with Assistant Executive Director, Brandee Butler, and explained the purpose of today’s visit. Adminstrator Loreen Hickman was not available during this visit. The facility is currently licensed to serve 47 ambulatory and non-ambulatory elderly residents. The facility is approved for 5 hospice residents. LPA and Brandee inspected the facility’s physical plant including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, parlor area, common TV area, activity area and outside of the facility. The facility is a two-story building located in a residential neighborhood. There were no bodies of water were observed at this time. Entrance, exits and hallways were observed to be clear of obstructions. LPA observed an evacuation chair located near the entrance door by the reception area. Facility has one elevator and was observed to be operational at this time. The facility common areas, including the activity room, dinning hall, parlor/living room, and hallways, were observed to be organized and free from debris. LPA inspected 5 resident apartments. LPA observed beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage for the resident's personal belongings. Bathrooms were operational and adequately supplied including with grab bars and non-skid flooring. Hot water in 5 of 5 resident bathroom faucets were measured between 108 and 113 degree Fahrenheit. Smoke detectors and carbon monoxide were observed in each of the inspected apartments. The kitchen was inspected, and was observed to be clean and free of clutter. Facility maintains a sufficient 2-day perishable and 7-day non-perishable food. Room temperature was maintained in the facility at 71 degrees F in the hallway and 72 degree F in one resident apartments. Two fire extinguisher were inspected and both were serviced on 11/26/24. Medications were observed to be stored in the locked medication room near the the reception and office area. {1 of 2} Medications were observed to be locked and inaccessible to residents in care. Sharp objects, poisonous substances and other dangerous items were observed to be inaccessible to residents in care. During this visit, LPA conducted an audit of facility files, 7 resident files, and 5 staff files for regulatory compliance. The 7 resident files reviewed contained to documents including updated admission agreements, medical assessments, and needs and services plan as required. 5 of 5 staff were noted to have criminal background clearances and associated to this facility. The 5 staff files reviewed contained documents including health screening, TB results, current first aid, and initial and ongoing training. Facility conducts quarterly fire drills and last drill was conducted in November 2024. LPA requested an updated copy of LIC 308, LIC 500, and liability insurance certificate to be sent to the Department by 2/21/25. At this time, no citations are being cited. An exit interview was conducted and a copy of this report was provided. {2 of 2}the state’s words, verbatim · CDSS document, Feb 20, 2025

Allegation investigated: Facility did not provide responsbile party with former resident's records.

On 9/10/24 at 4:24pm, Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility unannounced to conduct a follow up complaint visit and deliver finding regarding the allegation noted above. LPA met with Loreen Hickman, Administrator and stated the purpose of this visit. The investigation involved conducting interviews and reviewing records from a prior complaint (control # 27-AS-20230816155055), alongside other pertinent documents, to address the allegation that Gold Quartz Inn Retirement Home (GQI) did not provide the Responsible Party (RP) with the records of the former resident (R1). Initially, the RP requested records on 6/13/23, prior to R1's death. RP requested comprehensive documentation since R1's admission on 11/1/22. On 6/16/23, the facility provided some documents to the RP; however, several pages, including those from the Hospice binder, were missing or incomplete. In response to subsequent requests from the RP on 6/25/23, and 6/28/23, which highlighted the missing pages and documents, the facility communicated further updates. Unfounded On 628/23, the facility informed the RP that the missing pages from the hospice documents were not available due to being provided in incomplete form by the hospice provider. Following R1's death, the RP, also the Power of Attorney (POA), formally requested a complete set of records on 8/11/23. GQI responded by stating that while they would provide some documents, they could not release all requested records due to regulatory and contractual limitations. A regulatory and legal review revealed that the Department of Social Services indicated that a POA’s authority terminates upon the resident's death. Consequently, the facility was not obligated to release resident records after their death. GQI’s position was that no specific law required them to release all requested records after the resident’s death, though they did agree to provide payment records and relevant care documents. The facility had provided the majority of the requested documents, excluding those from the hospice, which were property of the hospice provider and not directly controlled by GQI. Administrator Loreen Hickman and Licensee Ronald Regan confirmed that the facility had furnished all available documents and addressed any missing pages from their own records. The remaining documents were under the hospice provider's control. An appeal of the facility’s actions was reviewed, and the Department concluded that GQI’s response adhered to regulatory requirements. The facility had complied with providing all available records and clarified that some documents were beyond their control. In conclusion, the investigation found no evidence that the facility did not provide the requested records beyond their control or contrary to regulatory obligations. Therefore, the allegation is deemed UNFOUNDED. Note that a finding that is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Based on today’s visit, no deficiencies are being cited. After discussing the findings, Administrator needed to leave the facility and assigned staff on duty (S1) to sign this report on behalf of the Administrator, An exit interview was conducted with S1 and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 10, 2024 · control 27-AS-20240312154531

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct a case management - deficiencies visit. LPA met with Administrator Loreen Hickman, and explained the purpose of the visit. On 09/26/2023, The Regional Office substantiated allegations for complaint 27-AS-20230920142634. The Licensee appealed the decision. The appeal was granted, and the citation with the related $500 civil penalty was dismissed. However, a violation still exists for 22 CCR § 87468.2(a)(4) for staff failure to ensure R1’s wheelchair lock in the transport van was secured resulting in R1 and the wheelchair falling to the floor. LPA toured the facility and observed no immediate health or safety concerns. LPA requested and obtained a copy of the current staff roster. Per California Code of Regulations (CCR) - Title 22, deficiencies are being cited on the attached LIC 809-D page. Appeal Rights were provided. An exit interview was held, a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 16, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Apr 23, 2024

87468.2 Additional Personal Rights of Residents...(a)In additionto...Section 87468.1... residents... shall have all of the following personal rights: (4)To care, supervision, and services that meet their individual needs...This requirement was not met as evidenced by: Based on records review and interviews, the licensee neglected to ensure R1's needs were met by staff, which resulted in R1 falling to the floor while in a moving vehicle. This poses a potential health and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 16, 2024

Plan of correction: Licensee to submit copies of in-service training for Transportation Procedures conducted for 2023 and 2024 for all staff by POC due date.

Type of visit: Required - 1 Year

On 2/6/24, at 10:30am, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced annual required visit, with the use of the CARE Inspection Tool. LPA met with Loreen Hickman, Executive Director (ED) and explained the purpose of today’s visit. The facility is currently licensed to serve 47 ambulatory and non-ambulatory elderly residents. The facility is approved for 6 hospice residents. At 11am, LPA inspected the facility’s physical plant including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, parlor area, common TV area, activity area and outside of the facility to ensure compliance with Title 22 regulations. The facility is a two-story structure located in a residential neighborhood. There were no bodies of water on the premises. Entrance, exits and hallways were observed to be clear of obstructions. LPA inspected 4 resident apartments. LPA observed beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage for the resident's personal belongings. Bed linens, comforters, and bath towels were adequately stocked during the visit. Bathrooms were operational and adequately supplied including with grab bars and non-skid flooring. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were locked and not accessible to residents in care. The kitchen was inspected, and was observed to be clean and free of clutter. Facility maintains a sufficient 2-day perishable and 7-day non-perishable food. Room temperature was maintained in the facility at 74 degrees F in the hallway and 72 degree F in one resident apartments. Water temperature in two resident bathrooms were measured at 114 degrees F. Two fire extinguisher were inspected and both were serviced on 11/21/23. Smoke detectors and carbon monoxide were observed in each of the inspected apartments and found to be operable during this visit. {Con't to LIC809-C} {Con't from LIC809} Medication storage area was observed to be locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and accessible to staff. The facility maintains for each resident Centrally Stored Medication, Destruction Record and PRN Log. LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed personal rights, resident council and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility’s activity calendar and sufficient equipment and supplies to meet activity program needs of residents in care. During this inspection, LPA conducted an audit of facility files, 5 resident files, and 5 staff files for regulatory compliance. All staff noted on the facility staff roster have criminal background clearances and associated to this facility. Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Staff files reviewed contained all required contents including health screening, TB results, current first aid, and initial and ongoing required trainings. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts quarterly fire drills. LPA requested an updated copy of LIC 308, LIC 500, and liability insurance certificate. Per California Code of Regulations (Title 22, Division 6, Chapter 8), no deficiencies were observed during this visit. An exit interview was held with Loreen Hickman, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Feb 6, 2024