Golden Moments Care Home Winding Way

Allegation investigated: Facility staff are not providing incontinence care to residents in need. Facility is not providing adequate care and supervision. Facility is not providing night supervision.

On May 22, 2026, the Department concluded a complaint investigation regarding the allegations listed above. The care home is closed. Licensing Program Analyst (LPA) Michael Hood sent a copy of this report via certified mail to Licensee, Mark Graham, to deliver complaint investigation findings. During the investigation, the department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Interview with staff member (S1) conducted on February 14, 2026, indicated that resident (R1) receives baths in bed and receives assistance with changing their briefs. S1 stated that R1 was changed three (3) times that day. S1 stated that R1 needs to be repositioned every two (2) hours and needs to be changed every two (2) hours. ** Report continued on 9099-C ** Substantiated S1 stated that they will come to work after Licensee has worked overnight and they observe that nothing has been done overnight. S1 stated that Licensee sleeps during their shift. S1 stated that they have arrived at the facility and resident (R2) will have a full blown diaper, in which they have sat in poop two (2) or three (3) times over. S1 stated that laundry and dishes are not done while Licensee works. S1 stated that they have observed food from the other night still out upon reporting to work. S1 stated that the dishwasher will be full and not started and the care home will have no clean dishes. S1 stated that Licensee does not check the resident rooms at night. S1 stated it is clear that Licensee sleeps throughout their shift. During visit conducted on February 18, 2026, LPA and Licensing Program Manager (LPM) Lauren Crocker toured the premises and conducted interviews, including R1, Licensee, and House Manager, Stephanie Harmon-Christensen. LPA and LPM also reviewed records for the residents. Interview with Licensee indicated that they did not document a pre-appraisal for R1. Interview with R1 indicated that the facility is understaffed and staffing is inadequate at the facility. R1 stated that only the Licensee works at night and they are concerned about their health. R1 stated that Licensee has muscle spasms and is unable to safely change and reposition R1 in bed. R1 stated that they have almost fallen off the bed while Licensee was attempting to change them. R1 stated that Licensee cannot put R1's diapers on correctly. R1 stated that they can observe that they smell like pee and haven't been cleaned or showered. R1 stated that they go pee every hour and pee twice per diaper change. R1 stated that the diapers being used by the facility are too small. R1 is using two (2) XL diapers but R1 stated that they need a size 5XL. As a result of the visit conducted on February 18, 2026, a deficiency was cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87468.1 Personal Rights of Residents in All Facilities (a) “Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.” This requirement was not met based on interviews conducted and observations, which determined that the facility did not ensure to provide R1 with safe equipment to meet the resident's needs, including wearable diapers. Facility was required to obtain an adequate supply of 5XL diapers for resident in need. ** Report continued on 9099-C ** Interviews with S1 and House Manager indicated that Licensee would work NOC shift and sleep through their shift. House Manager stated that staff member (S3) would also sleep through their shift. Physician’s Report (LIC 602A) for R2 states R2 needs “total dependent assistance” for all activities of daily living (ADLs). Resident Appraisal for R2 on file states that R2 needs special observation/night supervision (due to confusion, forgetfulness, wandering) as they are “unable to get out of bed/supervision.” Appraisal/Needs and Services Plan for R2 dated December 18, 2025 states R2 “needs assistance with all activities and all ADL’S.” S1 stated that R2 has cut their arm from falling out of bed. S1 stated that R2 has fallen out of bed twice during Licensee's shift. S1 stated that S3 has left R2 on the floor because they couldn't get R2 up on their own. S1 stated that S3 gave R2 a blanket and pillow while they laid on the floor. S1 stated that the floors are hard. S1 stated that they did not know when R2 fell. S1 stated that resident (R3) has fallen and resident (R4) has fallen out of bed (LPA verified Incident Reports submitted regarding falls for both residents). S1 stated that all falls have been during Licensee's shift. S1 stated that R3's most recent fall was at approximately 7:15 AM ending in Licensee's shift. S1 stated that they lifted R3 into bed and called the paramedics. S1 stated that R3 bumped their head. S1 stated that House Manager told S1 to call paramedics. The Department received information from R2’s Home Health (HH) regarding R2’s fall. HH reported that R2 is mostly bedbound and is unable to turn or transfer self. HH reported to have visited R2 on January 3, 2026. HH reported that staff member (S2) stated that R2 had an unwitnessed fall and night shift caregiver (S3) left R2 on the floor for possibly one (1) to two (2) hours. HH reported that S2 had stated that S3 did not call supervisor until the end of their shift. HH reported that supervisor found R2 soaked in urine and blood to their right arm while face down on the floor next to their bed. HH reported that supervisor contacted paramedics and R2 was returned to bed and provided basic wound care. HH reported assessing R2’s arm and found no signs of infection. HH reported providing R2 wound care and instructing care staff regarding wound care as ordered by physician. HH reported providing extensive fall prevention education to care staff. HH recommended bed alarms and 24 hour closer supervision. ** Report continued on 9099-C ** HH reported a new rash that is possibly incontinence related with no open areas. HH reported both injuries to be deemed not serious injuries. PIN 25-06-ASC states the following: “to ensure resident safety, licensees as a best practice should immediately call 9-1-1 if a resident is experiencing any of the following symptoms/conditions listed below: (…) Falls with complaints of pain or loss of range of motion.” On February 20, 2026, the Department received a report from the Local Long Term Care Ombudsman authored by Sacramento Metro Fire Department. The report states the following: “On February 19th at 1212am, Engine 32 and Medic 32 responded to Golden Moments Care Home for a person complaining of abdominal pain and stated there were no staff in the facility. Upon arrival, [medical personnel] was unable to find any staff at the care facility. [R1], a resident at the facility who weighs approximately 550 lbs was found holding onto [their] bed and table and about to fall to the floor. [R1] stated [they] had been yelling for help for approximately 2 hours with no staff responding. After 10 minutes, [S2], an employee entered through the front door and stated [they were] on [their] lunch break and had been gone for at least an hour. [S2] then went and retrieved Mr. Mark Graham, the facility owner, who was asleep in a back bedroom. [S2] initially stated [they] had permission to leave for [their] lunch, but Mr. Graham stated [they were] not aware [S2] had left. [R1] was subsequently left yelling for help for abdominal pain and clinging to [their] bed to prevent from falling to the floor for anywhere from one to two hours. [Medical personnel] informed Mr. Graham that [they] would be transporting [R1] to the ER for [their] medical complaint and requested any records including medical history and medications for [R1]. After 10 minutes, [Licensee] was unable to provide a single piece of information regarding [R1] including name, birthday, emergency contact, medical history, medications, etc.. [Medical personnel] asked [them] for a copy of an intake form, which [they were] unable to provide. [Medical personnel] advised Mr. Graham that [medical personnel] would be filling an APS report due to the abandonment of [R1] and failing to provide any information regarding a person in [their] care.” ** Report continued on 9099-C ** Interview with S2 conducted on February 19, 2026, indicated that they were working the previous night with Licensee. S2 stated that they texted Licensee that they would be leaving on their lunch break to get gas. S2 stated that Licensee did not respond to their text message prior to leaving the care home. S2 stated that, when they returned to the facility, they found the fire department at the care home taking R1. S2 stated that the fire department was mad and didn't tell S2 much. S2 stated that they told the fire department that Licensee was at the facility. S2 stated that Licensee was sleeping in a resident room and had to be woken up for the fire department. Interview with R1 conducted on February 27, 2026, indicated that they were yelling for two (2) hours for assistance before contacting the fire department. R1 stated that they didn’t believe that Licensee was on the premises. R1 stated that, if the house had been on fire, they would be dead. R1 stated that they had been experiencing stomach pain and was wanting Tylenol. R1 stated that they were also having difficulty breathing. R1 stated that they did not want to return to the care home. Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D pages. Facility is closed. A copy of this report and appeal rights were provided to the Licensee via certified mail. Interviews conducted with staff and residents did not indicate any concerns regarding staff physically abusing residents in care at the care home. LPA did not observe any evidence of physical abuse from staff towards residents during the investigation. Based on interviews conducted and observations, the preponderance of evidence standards have not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Facility is closed. A copy of this report was provided to the Licensee via certified mail.the state’s words, verbatim · CDSS document, May 22, 2026 · control 59-AS-20260113183412

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: May 23, 2026

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interviews conducted, observations, and records reviewed, the facility did not ensure to provide basic services to residents in need, which poses an immediate health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, May 22, 2026

Plan of correction: Facility has been closed and no longer has residents in care. There will be no additional plan of corrections as the care home is now closed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: May 23, 2026

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interviews conducted, observations, and records reviewed, the facility did not ensure to observe the residents for changes in condition and seek attention for unmet needs, which poses an immediate health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, May 22, 2026

Plan of correction: Facility has been closed and no longer has residents in care. There will be no additional plan of corrections as the care home is now closed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87415(a)(1) · Plan of correction due date: May 23, 2026

87415 Night Supervision (a) The following persons providing night supervision from l0:00 p.m. to 6:00 a.m. shall be familiar with the facility's planned emergency procedures, shall be trained in first aid as required in Section 87465, Incidental Medical and Dental Care Services and shall be available as indicated below to assist in caring for residents in the event of an emergency. (1) In facilities caring for less than sixteen (16) residents, there shall be a qualified person on call on the premises. This requirement is not met as evidenced by: Based on interviews conducted, observations, and records reviewed, the facility did not ensure that overnight staff were on-call to provide basic services to residents in care, which poses an immediate health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, May 22, 2026

Plan of correction: Facility has been closed and no longer has residents in care. There will be no additional plan of corrections as the care home is now closed.

Allegation investigated: Residents in care sustained injuries due to staff neglect/lack of supervision Facility is not financially solvent Staff mismanaged residents’ medications There is no qualified administrator at the facility Facility is insufficiently staffed Staff are not providing adequate food service to residents in care Staff did not ensure that complete resident records were maintained at the facility Staff did not follow proper reporting requirements

On May 22, 2026, the Department concluded a complaint investigation regarding the allegations listed above. The care home is closed. Licensing Program Analyst (LPA) Michael Hood sent a copy of this report via certified mail to Licensee, Mark Graham, to deliver complaint investigation findings. During the investigation, the Department conducted interviews, toured the premises, conducted a medication count, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Allegation: Residents in care sustained injuries due to staff neglect/lack of supervision ** Report continued on 9099-C ** Substantiated Interviews with staff member (S1) and House Manager, Stephanie Harmon-Christensen, indicated that Licensee would work NOC shift and sleep through their shift. House Manager stated that staff member (S3) would also sleep through their shift. Physician’s Report (LIC 602A) for resident (R3) states R3 needs “total dependent assistance” for all activities of daily living (ADLs). Resident Appraisal for R3 on file states that R3 needs special observation/night supervision (due to confusion, forgetfulness, wandering) as they are “unable to get out of bed/supervision.” Appraisal/Needs and Services Plan for R3 dated December 18, 2025 states R3 “needs assistance with all activities and all ADL’S.” S1 stated that R3 has cut their arm from falling out of bed. S1 stated that R3 has fallen out of bed twice during Licensee's shift. S1 stated that S3 has left R3 on the floor because they couldn't get R3 up on their own. S1 stated that S3 gave R3 a blanket and pillow while they laid on the floor. S1 stated that the floors are hard. S1 stated that they did not know when R3 fell. S1 stated that resident (R2) has fallen and resident (R4) has fallen out of bed (LPA verified Incident Reports submitted regarding falls for both residents). S1 stated that all falls have been during Licensee's shift. S1 stated that R2's most recent fall was at approximately 7:15 AM ending in Licensee's shift. S1 stated that they lifted R2 into bed and called the paramedics. S1 stated that R2 bumped their head. S1 stated that House Manager told S1 to call paramedics. The Department received information from R3’s Home Health (HH) regarding R3’s fall. HH reported that R3 is mostly bedbound and is unable to turn or transfer self. HH reported to have visited R3 on January 3, 2026. HH reported that staff member (S2) stated that R3 had an unwitnessed fall and night shift caregiver (S3) left R3 on the floor for possibly one (1) to two (2) hours. HH reported that S2 had stated that S3 did not call supervisor until the end of their shift. HH reported that supervisor found R3 soaked in urine and blood to their right arm while face down on the floor next to their bed. HH reported that supervisor contacted paramedics and R3 was returned to bed and provided basic wound care. HH reported assessing R3’s arm and found no signs of infection. HH reported providing R3 wound care and instructing care staff regarding wound care as ordered by physician. HH reported providing extensive fall prevention education to care staff. HH recommended bed alarms and 24 hour closer supervision. ** Report continued on 9099-C ** HH reported a new rash that is possibly incontinence related with no open areas. HH reported both injuries to be deemed not serious injuries. PIN 25-06-ASC states the following: “to ensure resident safety, licensees as a best practice should immediately call 9-1-1 if a resident is experiencing any of the following symptoms/conditions listed below: (…) Falls with complaints of pain or loss of range of motion.” Based on the information above, the allegation is determined to be substantiated. Allegation: Facility is not financially solvent Upon opening the complaint on November 24, 2025, Licensee had yet to pay license fees for approximately two (2) years. By the conclusion of this investigation, all license fees have been paid. Upon opening the complaint on November 24, 2025, Licensee had yet to update liability insurance for the care home. By the conclusion of this investigation, liability insurance has been updated as of February 12, 2026. The Department referred allegation regarding financial solvency to Audit Section. On February 24, 2026, April 1, 2026, April 8, 2026, and April 14, 2026, auditor requested Licensee to provide requested documentation. As of the conclusion of this investigation, Licensee did not provide any requested documentation. Due to lack of documentation, auditor was unable to proceed with solvency audit. During visit conducted on April 14, 2026, LPA discovered that Licensee was issued a Notice of Filing Unlawful Detainer Complaint on April 8, 2026, which states "You are hereby notified that an Unlawful Detainer complaint (eviction action) has been filed against you." Interview conducted with Licensee on April 14, 2026 indicated that Licensee only paid partial rent for March, 2026 and had yet to pay rent for April, 2026. As a result of the visit conducted on April 14, 2026, a deficiency was cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87213 Finances - "The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents" (...). This requirement was not met based on interview conducted and records reviewed, which identified that Licensee did not ensure to secure funds to meet operating costs for care of residents. ** Report continued on 9099-C ** Based on the information above, the allegation is determined to be substantiated. Due to care home receiving a citation for Section 87213 Finances during visit conducted on April 14, 2026, no additional citations will be issued. There will be no additional plan of corrections as the care home is now closed. Allegation: Staff mismanaged residents’ medications During visit conducted on January 14, 2026, LPA arrived at the facility and conducted a medication count for residents R2 and R3, comparing residents' Centrally Stored Medication Forms (CSMFs) and Medication Administration Records (MARs) with medications centrally stored for the residents. LPA observed five (5) of six (6) medications counted for R2 to be over the amount documented. Interview with Licensee indicated that R2 has refused medications but refusals were not documented. LPA observed two (2) of four (4) medications counted for R3 to be under the amount documented. There was no documentation provided to account for why medications were off count by the conclusion of LPA's visit conducted on January 14, 2026. Based on the information above, the allegation is determined to be substantiated. Allegation: There is no qualified administrator at the facility During visit conducted on February 12, 2026, LPA discovered facility had yet to employ a certified administrator. As a result of the visit conducted on February 12, 2026, a deficiency was cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87405 Administrator - Qualifications and Duties (a) "All facilities shall have a qualified and currently certified administrator." This requirement was not met based on interviews conducted and observations, which determined that the facility did not ensure to employ a certified administrator. The facility was to hire a certified administrator and send proof of employment to LPA by plan of correction (POC) due date of February 24, 2026. Licensee did not provide proof of employment of an administrator to LPA by POC due date and a civil penalty in the amount of $100 a day was issued until the closure of the care home. ** Report continued on 9099-C ** Based on the information above, the allegation is determined to be substantiated. Due to care home receiving a citation for Section 87405 Administrator – Qualifications and Duties during visit conducted on February 12, 2026, no additional citations will be issued. There will be no additional plan of corrections as the care home is now closed. Allegation: Facility is insufficiently staffed During visit conducted on November 24, 2025, LPA observed S2 working at the facility by themselves. LPA observed that S2 did not have a criminal background clearance on file. During visit conducted on November 25, 2025, LPAs Michael Hood and Marisa Chiarelli observed S1 working at the facility without a criminal background clearance. As a result of the visit conducted on November 25, 2026, a deficiency was cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87355 Criminal Record Clearance (d) "All individuals subject to criminal record review shall be fingerprinted" (...) (3) "The licensee shall submit these fingerprints to the California Department of Justice, along with a second set of fingerprints for the purpose of searching the records of the Federal Bureau of Investigation, or comply with Section 87355(c), prior to the individual's employment, residence, or initial presence in the facility." This requirement was not met based on LPA's observations, which determined facility did not ensure that a criminal record clearance was obtained for two (2) staff members. During office meeting conducted on January 16, 2026, staffing concerns were discussed, including the need for hiring an interim Administrator. Licensee agreed to provide to LPA staff schedule bi-weekly as a result of the office meeting. During visit conducted on February 12, 2026, LPA observed that facility had yet to create a staff schedule to provide to LPA bi-weekly. Per interviews, LPA was informed that Licensee will have worked three (3) shifts in a row, including night shift for February 11, day shift for February 12, and night shift for February 12. As a result of visit conducted on February 12, 2026, a deficiency was cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87411 Personnel Requirements - General (a) "Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs." This requirement was not met based on interviews conducted and observations, which determined that the facility did not ensure to have sufficient staff to meet the residents’ needs. ** Report continued on 9099-C ** During visit conducted on February 18, 2026, LPA and Licensing Program Manager (LPM) Lauren Crocker toured the premises and conducted interviews, including resident (R1), Licensee, and House Manager. LPA and LPM also reviewed records for the residents. As a result of the visit conducted on February 18, 2026, a deficiency was cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87411 Personnel Requirements – General. This requirement was not met based on interviews conducted, observations, and records reviewed, which determined that the facility did not ensure to schedule staff to meet the needs of R1. Facility was required to schedule at minimum two (2) caregivers per shift to meet the level of care needs of the current residents and required to submit an updated staff schedule for the next six (6) weeks to LPA by POC due date of February 19, 2026. Based on the information above, the allegation is determined to be substantiated. Due to care home receiving a citation for Section 87411 Personnel Requirements – General during visits conducted on February 12, 2026 and February 18, 2026, no additional citations will be issued. There will be no additional plan of corrections as the care home is now closed. Allegation: Staff are not providing adequate food service to residents in care During visit conducted on November 24, 2026, LPA observed approximately 18 expired food items in the pantry and refrigerator of the care home. All expired food items were pulled and disposed of during visit. Based on LPA’s observations, the allegation is determined to be substantiated. Allegation: Staff did not ensure that complete resident records were maintained at the facility During visit conducted on January 14, 2026, LPA reviewed records for all residents residing at the care home. LPA observed Personal Rights records missing for two (2) residents, Safeguard of Property/Valuables records missing for two (2) residents, and identification and emergency information missing for one (1) resident. During visit conducted in February 18, 2026, LPA and LPM observed care home to be missing pre-admission appraisal for R1. As a result of visit on February 18, 2026, deficiencies were cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87457 Pre-Admission Appraisal due to care home not completing a pre-admission appraisal for R1 prior to admission. ** Report continued on 9099-C ** During visit conducted on April 16, 2026, LPA requested medication documentation pertaining to R3 from January 14, 2026 to February 10, 2026. Facility could not provide requested documentation to LPA by the conclusion of the inspection. As a result of the visit conducted on April 16, 2026, a deficiency was issued pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87465 Incidental Medical and Dental Care (h) "The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year" (...). The requirement was not met based on LPA's observations and records reviewed, which determined that the facility did not ensure to maintain records of R3's centrally stored medications for at least one year. Based on the information above, the allegation is determined to be substantiated. Allegation: Staff did not follow proper reporting requirements On December 19, 2025, LPA received an Unusual Incident/Injury Report (LIC 624) from House Manager for resident (R4) with a date occurred listed as December 11, 2025. LPA did not received LIC 624 within seven (7) days of the incident occurrence per Title 22 regulations. Interviews conducted with S1 and House Manager indicated that R2 reported that they received R4’s medications. House Manager stated that they did not submit an incident report to the Department regarding incident. Based on interviews conducted, the allegation is determined to be substantiated. Based on interviews conducted, observations, medication count, and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D pages. Facility is closed. A copy of this report and appeal rights were provided to the Licensee via certified mail. During investigation, LPAs Michael Hood and Marisa Chiarelli observed cameras in the common areas of the care home. LPA Michael Hood did not observe cameras placed in any resident bedrooms or bathrooms. Interviews conducted with staff indicated that cameras were not operable and no one could identify who had access to footage from the cameras. Cameras were removed from the common areas during the investigation. Based on interviews conducted and observations, the preponderance of evidence standards have not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Facility is closed. A copy of this report was provided to the Licensee via certified mail.the state’s words, verbatim · CDSS document, May 22, 2026 · control 59-AS-20251121101711

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: May 23, 2026

87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not ensure to contact 9-1-1 timely following the fall and sustained injury of R3, which poses an immediate health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, May 22, 2026

Plan of correction: Facility has been closed and no longer has residents in care. There will be no additional plan of corrections as the care home is now closed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: May 23, 2026

87465 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 LPA's observations, the facility did not ensure that medications were administered to residents as prescribed, which poses an immediate health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, May 22, 2026

Plan of correction: Facility has been closed and no longer has residents in care. There will be no additional plan of corrections as the care home is now closed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(8) · Plan of correction due date: Jun 4, 2026

87555 General Food Service Requirements (b) The following food service requirements shall apply: (8) 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 is not met as evidenced by: Based on LPA's observations, the facility did not ensure that food items on the premises were of good quality, which poses a potential health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, May 22, 2026

Plan of correction: Facility has been closed and no longer has residents in care. There will be no additional plan of corrections as the care home is now closed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Jun 4, 2026

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Based on observations and records reviewed, the facility did not ensure a complete and current record for each resident was maintained, which poses a potential health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, May 22, 2026

Plan of correction: Facility has been closed and no longer has residents in care. There will be no additional plan of corrections as the care home is now closed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Jun 4, 2026

87211 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. (...)(D) Any incident which threatens the welfare, safety or health of any resident (...). This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not ensure to report unusual incidents in accordance with Title 22, which poses a potential health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, May 22, 2026

Plan of correction: Facility has been closed and no longer has residents in care. There will be no additional plan of corrections as the care home is now closed.

Type of visit: Case Management - Other

On May 6, 2026, Licensing Program Manager (LPM) Lauren Crocker and Licensing Program Analyst (LPA) Michael Hood arrived unannounced at the facility to deliver a Temporary Suspension Order (TSO). The TSO shall be effective IMMEDIATELY. The Regional Office staff were met by caregiver, Isaiah Davis, upon arrival. Licensee, Mark Graham, was not available during today's visit. A call was made to the Licensee by LPA, LPM, and from the facility phone. Calls did not ring and were sent straight to voice message. Voice mailbox was full and no calls were able to leave a voice message. LPM and LPA conducted a tour of the facility and observed that there are currently no residents residing at the care home. LPM reviewed the TSO paperwork and left copies along with appeal rights. Declaration of service documented. Exit interview conducted and report provided.the state’s words, verbatim · CDSS document, May 6, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with House Manager, Stephanie Harmon-Christensen, to conduct a health and safety check. During visit, LPA received and reviewed proof of corrections and cleared deficiencies. LPA observed a 60-day notice provided to resident (R1) and observed notice to be unlawful per Health and Safety code. The facility currently does not have a certified administrator. A civil penalty in the amount of $600 was assessed for today's date due to failure to correct a citation regarding obtaining a certified administrator. Another civil penalty in the amount of $600 was assessed for today's date due to failure to correct a citation regarding issuing a refund to a resident's authorized representative following their death. As a result of today's inspection, a deficiency is being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiency is listed on 809-D. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, May 4, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.683(a) · Plan of correction due date: May 17, 2026

§1569.683 Eviction notices; reasons for eviction contents; service (a) In addition to complying with other applicable regulations, a licensee of a residential care facility for the elderly who sends a notice of eviction to a resident shall set forth in the notice to quit the reasons relied upon for the eviction, with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. In addition, the notice to quit shall include all of the following: (...) This requirement is not met as evidenced by: Based on observations and records reviewed, the facility did not ensure that 60-day notice issued to R1 complied with the Health and Safety code, which poses a potential heatlh, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, May 4, 2026

Plan of correction: Facility will issue a lawful 60-day notice to R1 in accordance with Title 22 and the Health and Safety Code. Facility will provide copy of 60-day notice to LPA by POC due date of May 17, 2026.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with House Manager, Stephanie Harmon-Christensen, to conduct a health and safety check. The facility currently does not have a certified administrator. A civil penalty in the amount of $800 was assessed for today's date due to failure to correct a citation regarding obtaining a certified administrator. Another civil penalty in the amount of $400 was assessed for today's date due to failure to correct a citation regarding issuing a refund to a resident's authorized representative following their death. No deficiencies are being cited as a result of today's visit. Exit interview was conducted. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 28, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with House Manager, Stephanie Harmon-Christensen, to conduct a case management visit to follow-up regarding information the Department obtained on April 17, 2026. LPA received information that Licensee was served an Unlawful Detainer Complaint on April 19, 2026. As of April 17, 2026, all necessary parties have been notified of Unlawful Detainer Complaint. On April 10, 2026, the facility was given a Final Notice that electric service was about to be turned off. The date that the power would be shut off was April 16, 2026. Interview with Licensee indicated that the electric bill was paid. LPA observed that electricity was not shut off as of April 20, 2026. Licensee has yet to provide notices to all necessary parties regarding Final Notice that electric services were to be turned off. The facility currently does not have a certified administrator. A civil penalty in the amount of $600 was assessed for today's date due to failure to correct a citation regarding obtaining a certified administrator. As a result of today's inspection, a deficiency is being cited pursuant to Health and Safety Code Section §1569.686 due to Licensee not issuing notices to all necessary parties regarding Final Notice that electric services were to be turned off. Deficiency is listed on 809-D. A licensee who does not comply with this section may be liable for civil penalties in an amount not to exceed one hundred dollars ($100) for each day the facility did not provide notification required in Health and Safety Code Section §1569.686. A civil penalty in the amount of $800 was issued today per Health and Safety Code Section §1569.686. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 20, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 1569.686(a)(5) · Plan of correction due date: Apr 21, 2026

§1569.686 Licensee notification of specified events; department initiation of compliance plan, noncompliance conference, or other appropriate action; penalties; exception (a) A licensee shall notify the department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their legal representatives, in writing, within two business days, and shall notify all applicants for potential residence, and, if applicable, their legal representatives, prior to admission, of any of the following events, or knowledge of the event: (5) A utility company has sent a notice of intent to terminate electricity, gas, or water service on the property within not more than 15 days of the notice. This requirement is not met as evidence by: Based on interviews conducted and records reviewed, the facility did not issue notices to all necessary parties regarding Final Notice that electric service was about to be turned off, which poses a potentional health, safety, and/or personal rights risks to the residents in care.the state’s words, verbatim · CDSS document, Apr 20, 2026

Plan of correction: Facility will notify the Department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their legal representatives, in writing, regarding Final Notice that electric service was about to be turned off by POC due date April 21, 2026. A civil penalty in the amount of $800 was issued today per Health and Safety Code Section §1569.686, which includes each day that the facility did not notify all necessary parties of Final Notice that electric service was about to be turned off from two days after the notice was issued on April 10, 2026.

Allegation investigated: Questionable Death.

Licensing Program Analyst (LPA) Michael Hood arrived at the care home and met with House Manager, Stephanie Harmon-Christensen, to deliver findings regarding the complaint allegation listed above. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Allegation: Questionable death. Relevant party reported that to the Department concerns regarding the passing of resident (R1), who may have experienced medication mismanagement at the facility that contributed to their passing. ** Report continued on 9099-C ** Unsubstantiated Death Report LIC 624A submitted to the Department regarding R1's death states R1 passed away on February 10, 2026. Death report states "county called [spouse], who shared with [staff] that they refused to do an autopsy. They told [spouse] sense [R1's] airways were cleared, there was no need to do an autopsy." On April 2, 2026, the Department obtained R1's death certificate by mail. R1’s date of death is listed as February 10, 2026. R1's immediate cause of death is listed as cardiopulmonary arrest, with the time interval between the onset and death noted in minutes. The underlying conditions contributing to R1’s death are a history of ischemic stroke, with the time interval between the onset and death noted in months. No other significant conditions contributed to R1’s death. R1’s death was reported to the Sacramento County Coroner’s office and no biopsy or autopsy was performed. On January 14, 2026, LPA conducted a medication count for R1, comparing R1's Centrally Stored Medication Form (CSMF) and Medication Administration Record (MAR) with medications centrally stored for the resident. LPA did not observe any evidence of R1 missing medications. LPA requested medications records from January 14, 2026 to February 10, 2026. Facility was unable to provide requested medication records to LPA by April 16, 2026. LPA cited facility for records in a separate inspection report conducted on April 16, 2026. Interview conducted with resident (R2) indicated that they have never witnessed any incidents of residents being neglected at the facility. R2 stated that they have no concerns regarding medication administration at the facility, they feel their care needs are being met at the facility, and they are treated well by facility staff. Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 16, 2026 · control 59-AS-20260223091811

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with House Manager, Stephanie Harmon-Christensen, to conduct a case management visit regarding information obtained during a separate inspection conducted on April 16, 2026. During visit, LPA requested medication documentation pertaining to resident (R1) from January 14, 2026 to February 10, 2026. Facility could not provide requested documentation to LPA by the conclusion of this inspection. Per Title 22, Division 6, Chapter 8, Section 87755 "(c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours." Per Title 22, Division 6, Chapter 8, Section 87506, "(e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident." Per Title 22, Division 6, Chapter 8, Section 87465, "(h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year (...)." As a result of today's inspection, a deficiency is being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiency is listed on 809-D. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 16, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(6) · Plan of correction due date: Apr 30, 2026

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year (...). This requirement is not met as evidenced by: Based on LPA's observations and records reviewed, the facility did not ensure to maintain records of R1's centrally stored medications for at least one year, which poses a potential health, safety, and/or personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Apr 16, 2026

Plan of correction: Facility will ensure to maintain records for all centrally stored medications for at least one year. Facility will complete a statement of understanding regarding regulation 87465 and submit statement to LPA by POC due date of April 30, 2026.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with House Manager, Stephanie Harmon-Christensen, to conduct a case management visit to follow-up regarding information obtained during visit conducted on April 14, 2026. During visit conduct on April 14, 2026, LPA discovered that Licensee, Mark Graham, was issued a Notice of Filing Unlawful Detainer Complaint on April 8. 2026, which states "You are hereby notified that an Unlawful Detainer complaint (eviction action) has been filed against you." Interview conducted with Licensee on April 14, 2026, indicated that Licensee only paid partial rent for March, 2026 and had yet to pay rent for April, 2026. As a result of today's inspection, a deficiency is being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiency is listed on 809-D. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 15, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87213 · Plan of correction due date: Apr 30, 2026

87213 Finances The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents (...). This requirement is not met as evidenced by: Based on interview conducted and records reviewed, the facility did not ensure to secure funds to meet operating costs for care of residents, which poses a potential health, safety, and/or personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Apr 15, 2026

Plan of correction: Facility will issued a 60-day notice to resident in care regarding change of ownership and the relinquish of current license. Facility provide copy of 60-day notice to LPA by POC due date of April 30, 2026.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Hood and Licensing Program Manager (LPM) Lauren Crocker arrived at the facility and met with House Manager, Stephanie Harmon-Christensen, to conduct a health and safety check. During visit, LPA and LPM spoke with Licensee, Mark Graham, via telephone call to discuss concerns regarding financial solvency. The facility currently does not have a certified administrator. A civil penalty in the amount of $500 was assessed for today's date due to failure to correct a citation regarding obtaining a certified administrator. No deficiencies are being cited as a result of today's visit. Exit interview was conducted. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 14, 2026

Allegation investigated: Staff did not issue a refund to the resident's authorized representative

Licensing Program Analyst (LPA) Michael Hood arrived at the care home and met with House Manager, Stephanie Harmon-Christensen, to deliver findings regarding the complaint allegation listed above. During the investigation, LPA conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Allegation: Staff did not issue a refund to the resident's authorized representative Relevant party reported that resident (R1) resided at the facility and passed away on January 29, 2026. Relevant party reported R1's rent was paid in advance for the month of February, 2026 prior to R1's passing. Relevant party reported that R1's authorized representative did not receive a prorated refund for rent that was paid in advance for the month of February, 2026. ** Report continued on 9099-C ** Substantiated LPA received proof of payment from R1's authorized representative confirming that R1's rent was paid in full from admission date of October 30, 2025, to February 28, 2026. Interview conducted with Licensee on March 24, 2026 indicated that they were not aware whether or not a refund was issued to R1's authorized representative following their passing. Licensee was to provide any information regarding whether refund was issued to R1's authorized representative. As of the April 9, 2026, LPA has not received any information from Licensee regarding refunds issued to R1's authorized representative. LPA reviewed R1's Admission Agreement signed by R1's authorized representative with an admission date of October 30, 2025, which states "Fees paid in advance will be refunded within 30 days. The total monthly rate set forth in the admission agreement will be prorated on a daily basis upon the resident's admission to, or permanent departure from, the facility during the month. All refunds shall be issued within 30 days...Advance notice to terminate this agreement upon the death of a resident is not required and fees cannot accrue once all personal property belonging to a deceased resident has been removed from the facility. Any agreement to leave personal property must be approved by Administrator (not by caregiving staff)." Per Health and Safety Code §1569.652(c), “A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed.” Per Title 22, Division 6, Chapter 8, Section 87505(h)(4), “The admission agreement shall not contain the following: Any provision that violates the rights of any residents including but not limited to those specified in Section 87468 and in Health and Safety Code section 1569 et seq.” Interviews conducted with relevant party, house manager, and staff member (S1) indicated that R1's authorized representative removed R1's personal property from the care home on January 29, 2026. Based on interviews conducted and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per Health and Safety Code, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 9, 2026 · control 59-AS-20260317095212

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Apr 24, 2026

§1569.652 Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not ensure to issue a refund for advance fees paid to R1’s authorized representative upon the removal of R1’s property after they passed away, which poses a potential health, safety, and/or personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Apr 9, 2026

Plan of correction: Facility will refund R1’s authorized representative fees paid from January 30, 2026 to February 28, 2026. Facility will submit proof that refund was issued by POC due date of April 24, 2026.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with House Manager, Stephanie Harmon-Christensen, to conduct a health and safety check. The facility currently does not have a certified administrator. A civil penalty in the amount of $1,700 was assessed for today's date due to failure to correct a citation regarding obtaining a certified administrator. No deficiencies are being cited as a result of today's visit. Exit interview was conducted. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 9, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with House Manager, Stephanie Harmon-Christensen, to conduct a health and safety check. The facility currently does not have a certified administrator. A civil penalty in the amount of $1,000 was assessed for today's date due to failure to correct a citation regarding obtaining a certified administrator. No deficiencies are being cited as a result of today's visit. Exit interview was conducted. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Mar 23, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with House Manager, Stephanie Harmon-Christensen, to conduct a health and safety check. The facility currently does not have a certified administrator. A civil penalty in the amount of $1,500 was assessed for today's date due to failure to correct a citation regarding obtaining a certified administrator. No deficiencies are being cited as a result of today's visit. Exit interview was conducted. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Mar 13, 2026

Type of visit: Office

On February 26, 2026, a non-compliance conference was conducted. The purpose of this conference meeting was to address non-compliance at the facility after being issued 16 Type A citations and 4 substantiated complaint allegations since being licensed March 29, 2022. Present in the meeting was CCLD staff, including Acting Regional Manager Troy Ordonez, Licensing Program Managers Lauren Crocker and Laura Munoz, and Licensing Program Analyst Michael Hood, and facility staff, including Licensee Mark Graham. The conference process was explained during this meeting. Issues discussed during this meeting were: · An overview of citations issued · Health and safety of the residents in care · Changes of ownership of the facility · Obtaining a certified administrator The facility has stated that they will do the following to achieve continued and substantial compliance: · House Manager will take over operations of the facility · Facility will ensure sufficient staffing to meet the needs of the residents in care · Facility will obtain a certified administrator Facility was notified that the Department may increase monitoring at the facility and the completing the Non-Compliance Conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager. A civil penalty in the amount of $200 was assessed for today's date due to failure to correct a citation regarding obtaining a certified administrator. Exit interview was conducted and a copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Feb 26, 2026

Type of visit: Office

An office meeting was conducted at 2:30pm on February 19, 2026, with Sacramento North Regional Office via Microsoft Teams. The purpose of this meeting was to discuss concerns regarding an incident that occurred at the facility on February 19, 2026 and to discuss facility's plans for future compliance. The following Licensing staff were present: Licensing Program Managers (LPMs) Lauren Crocker and Laura Munoz, and Licensing Program Analyst (LPA) Michael Hood The following facility representatives were present: Licensee Mark Graham and House Manager Stephanie Harmon-Christensen The following documents are being requested as a result of today's meeting: Proof that the facility hired an Administrator by February 23, 2026 Staff schedule removing Licensee from caregiver duties Licensing discussed steps towards changes of ownership during meeting. Facility representatives will follow up with LPA regarding any questions involving applications or the changes of ownership process. No deficiencies were cited. Exit interview was conducted. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Feb 19, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with House Manager, Stephanie Harmon-Christensen, to conduct a health and safety check. During visit, LPA conducted interviews and toured the premises. No deficiencies are being cited as a result of today's visit. Exit interview was conducted. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Feb 19, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Michael Hood and Licensing Program Manager (LPM) Lauren Crocker arrived at the facility and met with House Manager, Stephanie Harmon-Christensen, to follow-up on previously cited deficiencies and ensure the corrections have been made. During today's visit, LPA and LPM toured the premises and conducted interviews, including resident (R1), Licensee, House Manager. LPA and LPM also reviewed records for the residents. During visit, LPA cleared deficiencies that were corrected. LPA reviewed deficiencies that were not corrected and assessed civil penalties along with identifying additional deficiencies pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiencies cited for today are listed on the attached 809-D. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Feb 18, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Feb 19, 2026

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. (...) This requirement is not met as evidenced by: Based on interviews conducted, observations, and records reviewed, the facility did not ensure to schedule staff to meet the needs to resident (R1), which poses an immediate health, safety, and personal rights violation to the residents in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Facility will schedule at minimum two (2) caregivers per shift to meet the level of care needs of the current residents. Facility will submit and updated staff schedule for the next six (6) weeks by POC due date of February 19, 2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.1(a)(2) · Plan of correction due date: Feb 19, 2026

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by Based on interviews conducted and observations, the facility did not ensure to provide R1 with safe equipment to meet the resident's needs, including wearable diapers, which poses an immediate health, safety, and personal rights violation to the resident in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Facility will obtain an adequate supply of 5XL diapers for resident in need by POC due date of February 19, 2026. A civil penalty in the amount of $250 is assessed for today's date due to a repeat violation.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87457(a)(1) · Plan of correction due date: Feb 19, 2026

87457 Pre-Admission Appraisal (a) Prior to admission, the prospective resident and his/her responsible person, if any, shall be interviewed by the licensee or the employee responsible for facility admissions. (1) Sufficient information about the facility and its services shall be provided to enable all persons involved in the placement to make an informed decision regarding admission. This requirement is not met as evidenced by: Based on interviews conducted or records reviewed, the licensee did not provide sufficient information about the facility's services and staffing to resident (R1) to allow R1 to make an informed decision regarding admission, which poses an immediate health, safety, and personal rights violation to the residents in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Staff will obtain training regarding assessing residents and appropriate intakes from a third-party source. Facility will submit training date and source of training to LPA by POC due date of February 19, 2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87457(c) · Plan of correction due date: Feb 19, 2026

87457 Pre-Admission Appraisal (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This requirement is not met as evidenced by: Based on interviews conducted or records reviewed, the facility did not ensure to complete a pre-admission appraisal for resident (R1), which poses an immediate health, safety, and personal rights violation to the residents in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Facility will complete an appraisal of needs and services for R1 and submit documents to LPA by POC due date of February 19, 2026. The facility shall further have a medical professional do a full body assessment on R1 to identify any additional needs, services, or pressure injuries that need to be included in the residents needs and services plans. Send finalized needs and services plan to CCL for review upon completion.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87455(b)(8) · Plan of correction due date: Feb 19, 2026

87455 Acceptance and Retention Limitations (b) The following persons may be accepted or retained by the licensee: (8) Persons who are under 60 years of age whose needs are compatible with other residents in care, if they require the same amount of care and supervision as do the other residents in the facility. This requirement is not met as evidenced by: Based on interviews conducted, observations, and records reviewed, the facility did not ensure that resident (R1) had compatible needs with the other residents in care, which poses an immediate health, safety, and personal rights violation to the residents in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Facility will create a criteria for intake identifying the level of care and type of resident they will be accepting and retaining for the Department's review. Facility will submit criteria to LPA by POC due date of February 19, 2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.1(a)(1) · Plan of correction due date: Feb 19, 2026

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews conducted and observations, the facility did not ensure to treat all residents with dignity and respect, which poses an immediate health, safety, and personal rights violation to the residents in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Facility will complete a statement of understanding regarding regulation 87468.1 and submit statement to LPA by POC due date of February 19, 2026.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with caregiver, Isaiah Davis, to conduct a health and safety check. During visit, LPA attempted an interview with resident (R1) and reviewed documentation for R1. LPA also interview staff (S1) and toured the premises. Per R1's Medical Assessment dated February 13, 2026, R1 requires a wheelchair and hoyer lift for mobility, transfer, and repositioning. LPA did not observe a hoyer lift or wheelchair for R1 to use on the premises. S1 stated that R1 also discussed not feeling safe with current bed rails. As a result of today's inspection, a deficiency is being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiency is listed on 809-D. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Feb 14, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Feb 17, 2026

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on LPA's observations and records reviewed, the facility did not ensure to provide R1 with necessary comfortable equipment to meet the resident's needs, which poses a potential health, safety, and personal rights violation to the resident in care.the state’s words, verbatim · CDSS document, Feb 14, 2026

Plan of correction: Facility will obtain necessary equipment, including useable wheelchair, useable hoyer lift, and secured railings for bed, to meet R1's needs by POC due date of February 17, 2026.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with House Manager, Stephanie Harmon-Christensen, to conduct a health and safety check. During visit, LPA cleared deficiencies and followed up with items requested per office meeting conducted on January 16, 2026. LPA obtained liability insurance information during visit and found liability insurance to be current. Per interviews, facility has yet to employee a certified administrator. Facility has yet to create a staff schedule to provide to LPA bi-weekly. Per interviews, LPA was informed that Licensee will have worked three (3) shifts in a row, including night shift for February 11, day shift for February 12, and night shift for February 12. As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiencies are listed on 809-D. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Feb 12, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Feb 24, 2026

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. (...) This requirement is not met as evidenced by: Based on interviews conducted and observations, the facility did not ensure to have a certified administrator, which poses a potential health, safety, and personal rights violation to the residents in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: Facility will hire a certified administrator and send proof of employment to LPA by POC due date of February 24, 2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(a) · Plan of correction due date: Feb 24, 2026

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. (...) This requirement is not met as evidenced by: Based on interviews conducted and observations, the facility did not ensure to have sufficient staff to meet the residents needs, which poses a potential health, safety, and personal rights violation to the residents in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: Facility will complete a staff schedule and provide staff schedule bi-weekly to LPA by POC due date of February 24, 2026.

Type of visit: Case Management - Health Checks

On 01/21/2026 Licensing Program Manager (LPM) Troy Ordonez, Laura Munoz and Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct health and safety check met with house manager Stephanie Harmon-Christensen. Five (5) resident and two (2) staff present at the facility. During today's visit LPM and LPA reviewed resident records and obtained a copy of staff schedule. No deficiencies cited during today's visit. Exit interview conducted and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Jan 21, 2026

Type of visit: Office

An informal conference was conducted at 1:30 PM on January 16, 2026, with Sacramento North Regional Office. The purpose of this informal conference meeting is to address and discuss concerns regarding the most recent inspections conducted. Licensee was told that this Informal conference is a part of the Administrative Action process and that further noncompliance may result in an elevation to a formal noncompliance conference, which could lead to a referral to the Department's legal division for possible revocation of license. The following Licensing staff were present: Licensing Program Analyst (LPA) Michael Hood and Licensing Program Manager (LPM) Lauren Crocker The following facility representatives were present: Licensee, Mark Graham The following topics were covered during today's meeting: · An overview regarding 7 Type A citations, 9 Type B citations, and 4 civil penalties issued · Staffing, including hiring an interim Administrator (facility will provide to LPA staff schedule bi-weekly) · Liability insurance (facility will provide to LPA) · Record keeping for both staff and residents (Licensee will update health screening and provide to LPA) By February 6, 2026, Licensee will provide LPA with the requested items listed above. Facility was notified that the Department may increase monitoring at the facility. Technical support was offered to facility representative during meeting and the facility will be referred. An exit interview was conducted and a copy of this report will be provided to the facility via email.the state’s words, verbatim · CDSS document, Jan 16, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood and Licensing Program Manager (LPM) Lauren Crocker arrived at the facility unannounced on January 14, 2026 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and three (3) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 113 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. Emergency exits were unobstructed during visit. Fire extinguishers and first aid kit is maintained and ready for emergency use. LPA reviewed two (2) residents' medications and observed medication storage to be locked away and inaccessible to the residents. LPA reviewed five (5) resident files and three (3) staff files. As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiencies are listed on 809-D pages. Exit interview was conducted. A copy of this report and appeal rights were provided. Signatures on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Jan 14, 2026

Type of visit: POC

Licensing Program Analysts (LPAs) Michael Hood and Marisa Chiarelli arrived at the facility and met with Stephanie Harmon caregiver, to follow-up on a plan of correction made to the facility on November 25, 2025 to be corrected on November 26, 2025. During visit, LPAs observed staff files to be available for review and reviewed proof of training for staff. LPA Michael Hood obtained plan for staffing prior to visit. LPAs cleared deficiencies during visit. Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Dec 18, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Michael Hood and Marisa Chiarelli arrived at the facility and met with House Manager, Stephanie Harmon-Christensen, to address and discuss concerns regarding the most recent inspections conducted on November 24, 2025 and November 25, 2025. During visit conducted on November 24, 2025, LPA Hood observed staff member (S1) working at the facility by themselves. LPA observed that S1 did not have a criminal background clearance on file. S1 also did not have a First Aid/CPR card on file. During visit conducted on November 25, 2025, LPAs observed staff member (S2) working at the facility without a criminal background clearance. S2 also did not have a First Aid card on file. Facility was unable to provide any staff records during visit. As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Civil penalties in the amount of $100 each are being assessed today due a two (2) staff not receiving a criminal background clearance. Deficiencies are listed on 809-D. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Nov 25, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(d)(3) · Plan of correction due date: Nov 26, 2025

87355 Criminal Record Clearance (d) All individuals subject to criminal record review shall be fingerprinted... (3) The licensee shall submit these fingerprints to the California Department of Justice, along with a second set of fingerprints for the purpose of searching the records of the Federal Bureau of Investigation, or comply with Section 87355(c), prior to the individual's employment, residence, or initial presence in the facility. This requirement is not met as evidenced by: Based on LPA's observations, facility did not ensure that a criminal record clearance was obtained for two (2) staff members, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 25, 2025

Plan of correction: Facility will create a plan regarding staffing, including the process of hiring new staff. Facility will submit plan to LPA by POC due date. Civil penalties in the amount of $100 each were assessed for today's date regarding staff not having a criminal background clearance.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87411(c)(1) · Plan of correction due date: Nov 26, 2025

87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Based on LPA's observations, facility did not ensure that two (2) staff members had first aid training on file, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 25, 2025

Plan of correction: Facility will ensure that staff missing first aid training obtain first aid training. Facility will submit proof of completed training to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87412(f) · Plan of correction due date: Nov 26, 2025

87412 Personnel Records (f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. This requirement is not met as evidenced by: Based on LPA's observations, facility did not ensure to make personnel records available to licensing agency to inspect, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 25, 2025

Plan of correction: Facility will establish personnel records for licensing agency to inspect. LPA will return to facility at a later time to clear POC.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.618 · Plan of correction due date: Nov 26, 2025

§1569.618 Administration and management of residential care facilities; substituted qualifications; employee scheduling (c) The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Based on LPA's observations, the facility did not ensure that one (1) staff member had CPR training on file, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 25, 2025

Plan of correction: Facility will ensure that there is at least one (1) staff member on the premises who is CPR certified. Facility will ensure that staff missing CPR training obtain CPR training. Facility will submit proof of completed training to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Michael Hood and Licensing Program Manager (LPM) Lauren Crocker arrived at the facility and met with Licensee, Mark Graham, to address and discuss concerns regarding the most recent inspection conducted on August 18, 2025. During visit, LPA and LPM discussed with Licensee the importance of obtaining a criminal background clearance for volunteers prior to them providing supervision to the residents in care. LPA and LPM also discussed unpaid license fees. Licensee agrees to pay all license fees within 60 days of this report. Technical support was offered to facility representative during visit. As a result of today's inspection, a deficiency is being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. A civil penalty in the amount of $100 is being assessed today due a one (1) volunteer not receiving a criminal background clearance. Deficiency is listed on 809-D. Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Sep 4, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Sep 5, 2025

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department (...). This requirement is not met as evidenced by: Based on records reviewed, facility did not ensure that a criminal record clearance was obtained for one (1) volunteer, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 4, 2025

Plan of correction: Facility will complete a statement of understanding regarding criminal background clearances and ensure that volunteers obtain a criminal background clearance before providing services to residents. Facility will submit statement to LPA by POC due date. A civil penalty in the amount of $100 was assessed for today's date regarding staff not having a criminal background clearance.

Allegation investigated: Facility staff are not providing assistance with hygiene for residents in need. Facility staff are not providing assistance with incontinence care for residents in need. Staff are mistreating the residents in care. Staff do not ensure that facility is clean.

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with House Manager, Stephanie Harmon-Christensen, to deliver findings into the complaint allegations listed above. During the investigation, the Department toured the premises, conducted interviews, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Allegation: Facility staff are not providing assistance with hygiene for residents in need. ** Report continued on 9099-C ** Unsubstantiated LPA Sarah Benson conducted an inspection of the care home on July 1, 2025. LPA Benson reported touring the premises and conducting an interview with House Manager. Interview with House Manager indicated that residents at the care home shower twice a week. Staff reported the residents have never refused showers. LPA Benson observed the shower log for residents (R1 and R2) and observed two (2) showers recorded a week for both residents, with an exception of one (1) week for each resident in which one (1) shower was given. LPA Michael Hood conducted an inspection of the care home on August 18, 2025. Interviews conducted with House Manager, Licensee, Mark Graham, and R2 did not indicate any concerns regarding hygiene assistance provided to the residents in care. R2 stated that they are treated well by facility staff and they feel that their care needs are being met. House Manager and Licensee stated that residents receive showers twice a week. House Manager, Licensee, and R2 stated that they have never witnessed a resident in need of showers and not receiving assistance by facility staff. Interview with witness (W1) indicated that they have observed R1 soiled at the care home on one (1) occasion, but did not have any other concerns regarding showers and did not have any information regarding how long R1 was soiled. LPA Hood observed shower records for R2 for the month of June 2025. LPA Hood observed that R2 received two (2) showers a week. Local Long-Term Care Ombudsman (LTCO) reported to LPA Hood that they conducted a visit at the care home and did not observe any concerns regarding hygiene assistance for the residents in care. Allegation: Facility staff are not providing assistance with incontinence care for residents in need. LPA Sarah Benson conducted an inspection of the care home on July 1, 2025. LPA Benson reported touring the premises and conducting an interview with House Manager. LPA Benson reported observing the bedding of R1 and R2 and observing bedding to be clean. Interview with House Manager indicated that the residents' sheets are changed every shower day unless residents refuse, and laundry is done every shower day. ** Report continued of 9099-C ** LPA Michael Hood conducted an inspection of the care home on August 18, 2025. Interviews conducted with House Manager, Licensee, and R2 did not indicate any concerns regarding incontinence care provided to the residents in need. R2 stated that they are treated well by facility staff and they feel that their care needs are being met. House Manager and Licensee stated that residents are checked every two (2) hours to see if they are in need of incontinence care. House Manager, Licensee, and R2 stated that they have never witnessed a resident in need of incontinence care and not receiving it by facility staff. Interview with W1 indicated that they have observed R1 soiled at the care home on one (1) occasion, but did not have any other concerns regarding incontinence care and did not have any information regarding how long R1 was soiled. LTCO reported to LPA Hood that they conducted a visit at the care home and did not observe any concerns regarding incontinence care for the residents in need. Allegation: Staff are mistreating the residents in care. LPA Sarah Benson conducted an inspection of the care home on July 1, 2025. LPA Benson reported touring the premises and conducting an interview with House Manager. Interview with House Manager indicated that they have never yelled at the residents in care. LPA Michael Hood conducted an inspection of the care home on August 18, 2025. Interviews conducted with House Manager, Licensee, W1, witness (W2), and R2 did not indicate any concerns regarding staff mistreating the residents in care. R2 stated that they are treated well by facility staff and they feel that their care needs are being met. House Manager, Licensee, W1, W2, and R2 stated that they have never witnessed residents being mistreated at the facility. LTCO reported to LPA Hood that they conducted a visit at the care home and did not observe any concerns regarding staff mistreating the residents in care. Allegation: Staff do not ensure that facility is clean. LPA Sarah Benson conducted an inspection of the care home on July 1, 2025. LPA Benson reported touring the premises. LPA Benson observed the house to be clean, tidy, and free of odor. LPA Benson observed bedding for R1 and R2 to be clean. ** Report continued on 9099-C ** LPA Michael Hood conducted an inspection of the care home on August 18, 2025. Interviews conducted with House Manager, Licensee, W1, W2, and R2 did not indicate any concerns regarding the facility being unclean, malodorous, or in disrepair. During inspection, LPA Hood toured the premises and observed care home to be clean, in good repair, and free of odor. LPA Hood observed Cleaning Chart for All Shifts to be posted in the home, which documented housekeeping tasks completed by staff. House Manager and Licensee stated that housekeeping is conducted daily. LTCO reported to LPA Hood that they conducted a visit at the care home and observed home to be clean and in good repair. Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Aug 18, 2025 · control 59-AS-20250623114842

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 3/27/25 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and three (3) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 113 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. LPA reviewed two (2) residents' medications and observed medication storage to be locked away and inaccessible to the residents. LPA reviewed four (4) resident files and one (1) staff file. Facility has a current copy of certificate of liability insurance and LPA requested a copy. As a result of today's visit, a deficiency is being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiency is listed on the attached 809-D page. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Mar 27, 2025

Allegation investigated: Staff are mismanaging residents' medication

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Licensee, Mark Graham, to deliver findings regarding the complaint allegation listed above. During the course of the investigation, LPA conducted interviews, conducted a medication count, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Allegation: Staff are mismanaging residents' medication ** Report continued on 9099-C ** Substantiated During a visit conducted on 1/16/2025, LPA conducted a medication count for residents R2 and R4, comparing the residents' Centrally Stored Medication Form (CSM) with medications centrally stored for the residents. LPA observed one (1) medication for R2 that was off count in relation to what was documented. Medication that was off count was under the amount documented. There were no documentation to account for medication that was under the amount documented. LPA observed two (2) medications for R4 that were off count in relation to what was documented. One (1) medication that was off count was over the amount documented and one (1) medication that was off count was under the amount documented, There were no documentation to account for medications that were off count. Based on medication count, LPA's observation, and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted with Licensee. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents. Interview with Administrator, Mark Graham, indicated that resident (R1) was able to administer their own injectable medications. Interview with staff member (S2) indicated that they were responsible for making sure R1 received the right amount of their injectable medication, but R1 self administered their own injectable medication. LPA observed a Physician's Report LIC 602A for R1 dated 10/01/2024, which indicated that R1 was able to administered their own injectable medication. Interviews with resident R2, R3, and R4 indicated that they had no concerns regarding medication administration at the facility. Allegation: Staff are not meeting residents' hygiene needs Interviews with staff members S1, S2, and Administrator indicated that the residents receive sufficient care with bathing, grooming, and hygiene. Interviews with R2, R3, and R4 indicated that they had no concerns regarding facility staff assisting with bathing, grooming, and hygiene. LPA observed records documented by S2 showing multiple dates in which R1 refused showers. Allegation: Staff are not ensuring resident was seen by a doctor Interview with Administrator indicated that R1 had a doctor assigned to them outside of the area and was working on finding a local doctor. Administrator stated that R1 was resistant when facility attempted to assist R1 with locating medical assistance in the area. LPA observed After Visit Summaries dated 11/16/2024 and 12/06/2024 indicating that R1 was seen by a medical professional for different conditions. Interviews with R2, R3 and R4 indicated that they had no concerns regarding being seen by a doctor. Based on interviews conducted and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted with Licensee. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Jan 16, 2025 · control 59-AS-20241227081444

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jan 17, 2025

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) 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 medication count and records reviewed, the facility did not ensure that residents R2 and R4 were receiving medications as prescribed, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Facility will ensure that medications are being administered as prescribed. Facility will complete a statement of understanding regarding regulation 87465 and submit statement to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) arrived at the facility and met with Administrator, Mark Graham, to follow-up regarding observations made during an inspection conducted on 1/03/2025. LPA observed that staff member (S1) did not obtain a criminal background clearance prior to working at the facility on 1/03/2025. Due to LPA's observations and records reviewed, a deficiency is being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. A civil penalty in the amount of $100 is being assessed today due a one (1) staff member not receiving a criminal background clearance. Deficiency is listed on 809-D. Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Signatures on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Jan 15, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(j) · Plan of correction due date: Jan 16, 2025

87355 Criminal Record Clearance (j) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees in the individual's personnel file as required in Section 87412, Personnel Records. This requirement is not met as evidenced by: Based on records reviewed, facility did not ensure that a criminal record clearance was obtained for one (1) staff member, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 15, 2025

Plan of correction: Facility will complete a statement of understanding regarding criminal background clearances and ensure that new staff obtain a criminal background clearance before working with residents. Facility will submit statement to LPA by POC due date. A civil penalty in the amount of $100 was assessed for today's date regarding staff not having a criminal background clearance.

Allegation investigated: Licensee does not ensure facility has a certified administrator.

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Facility Manager, Stephanie Harmon-Christensen, to open a complaint into the allegation listed above. Prior to visit, LPA reviewed the Department's Administrator Certification records and observed that current listed Administrator and Facility Owner do not have an active administrator certificate. Interview with Facility Owner, Mark Graham, indicated that they do not have an active administrator certificate and there is no employee at the facility that currently has an active administrator certificate. Based on interviews conducted, LPA's observations, and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted with Facility Manager. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents. Substantiated Based on interviews conducted, LPA's observations, and records reviewed, the above allegations are found to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview was conducted with Facility Manager. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Oct 23, 2024 · control 59-AS-20241015174018

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Dec 24, 2024

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. (...) This requirement is not met as evidenced by: Based on interviews, LPA's observation, and records reviewed, the facility did not ensure to assign an Administrator with an active Administrator certificate, which poses an potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 23, 2024

Plan of correction: Facility will submit required paperwork to assign an individual with an active Administrator certificate as the facility's Administrator by POC due date of 12/24/2024.

Type of visit: POC

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Facility Owner, Mark Graham, to follow-up on a plan of correction made to the facility on 4/11/2024 to be corrected on 5/3/2024. Prior to today's visit, LPA confirmed that R1's representative received refund. During today's visit, LPA confirmed with Facility Owner that refund was submitted to R1's representative. LPA cleared deficiency during today's inspection. Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, May 14, 2024

Type of visit: POC

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Facility Owner, Mark Graham, to follow-up on a plan of correction made to the facility on 4/11/2024 to be corrected on 5/3/2024. LPA spoke with Facility Owner, who confirmed that refund has yet to be issued to resident R1's representative as of today's date. As a result of this visit, deficiency was observed to not be corrected and a civil penalty in the amount of $600 was assessed because the facility did not comply with a plan of correction for the time period of 4/11/2024 thru 5/3/2024. Exit interview was conducted with Facility Owner. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, May 9, 2024

Allegation investigated: Facility did not issue a refund

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Facility Owner, Mark Graham, to open a complaint into the allegation listed above. During today's visit, LPA interviewed Facility Owner. Facility Owner stated that resident (R1) was a prospective resident, that they chose not to move into the facility after paying a preadmission fee, and a written disclousure regarding refunds for preadmission fees was not given to R1's respresentative. Based on interviews conducted, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted with Facility Owner. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents. Substantiatedthe state’s words, verbatim · CDSS document, Apr 11, 2024 · control 59-AS-20240405111746

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(5)(E)1.b. · Plan of correction due date: May 3, 2024

87507 Admission Agreements (g) Admission agreements shall specify the following: (5) Refund conditions. (E) Preadmission fees shall be refunded according to the following conditions: 1. A 100 percent refund of a preadmission fee shall be provided to an applicant or the applicant’s representative if: b. The licensee fails to provide full written disclosure of preadmission fee charges and refund conditions. This requirement is not met as evidenced by: Based on interviews conducted, the facility did not issue a refund to R1's representative for a preadmission fee after R1's representative chose not to move R1 into the facility, which poses a potential health, safety, and personal rights violation to the residents in care.the state’s words, verbatim · CDSS document, Apr 11, 2024

Plan of correction: Facility will issue a full refund for preadmission fee to R1's respresentative by POC due date of 5/3/2024.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 3/14/24 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and three (3) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 115.6 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. LPA checked medication storage and found medication to be locked away and inaccessible to the residents. LPA reviewed three (3) resident files and two (2) staff files. Facility has a current copy of certificate of liability insurance and LPA requested a copy. As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Section 87203 regarding fire extinguishers not being serviced, Section 87309(a) regarding chemicals being accessible to residents, and Section 87615(a) regarding acceptance and retention of a resident with a prohibited health condition without an exception from CCLD. Deficiencies are listed on 809-D. Exit interview was conducted with caregiver. A copy of this report and appeal rights were provided. Signatures on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Mar 14, 2024