Golf View Home

Type of visit: Required - 1 Year

On 07/07/2026 at 11:00AM, Licensing Program Analysts (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Lorica Hipolito, Caregiver and explained the purpose of the visit. The Administrator Felecia Hughes currently holds a certificate (#7000732740) that expires on 04/19/2027. Administrator gave authorization for Lorica Hipolito, caregiver to sign documents. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of five (5) bedrooms, one (1) bedroom occupied by staff and two (2) bathrooms. LPA did not observe any bodies of water. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the resident’s shared bathroom was measured at 128.4 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and no skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last purchased on 05/05/2026. Emergency Disaster Plan was last reviewed on 07/01/2026. Fire drill was last conducted on 07/01/2026. First Aid kit was observed to be complete. Continue on LIC809C…. Continued from LIC809 LPA reviewed five (5) resident records and five (5) staff records, and they were current and complete. LPA requested the following documents to be submitted to CCLD by 07/14/2026. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report (updated) LIC 610E Emergency Disaster Plan The following deficiencies were cited during visit: At 11:00AM LPA observed facility has spider webs on covered entryway and windows. At 11:32AM LPA observed facility’s hot water measured 128.4 degree F. At 11:36AM LPA observed facility has spider webs and dust in hallways and residents’ bedrooms. At 11:36AM LPA observed facility has a wheelchair, Hoyer lift, and walkers in resident’s shared bathroom in master bedroom. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided to Lorica Hipolito.the state’s words, verbatim · CDSS document, Jul 7, 2026

Type of visit: Case Management - Incident

On 06/01/2026 at 11:00AM, Licensing Program Analyst (LPA) T.Syess-Gibson arrived unannounced to conduct a case management visit to follow-up on a death report received by Community Care licensing on 05/28/2026. LPA met with Lorica Hipolito, Licensee, and explained the purpose of the visit. Resident 1 (R1) passed away on 05/28/2026 with an unknown cause of death. Licensee stated the cause of death still has not been determined. During today's visit LPA obtained the following documents: Facility’s resident roster (LIC9020), staff schedule (LIC500), R1’s admission agreement, Physician’s report and home health care notes dated 05/01/2026-05/27/2026. LPA requested from facility a copy of R1's death certificate once available. No deficiencies cited during this visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 1, 2026

Type of visit: Required - 1 Year

On 06/04/2025 at 10:30AM, Licensing Program Analysts (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Marvin Misa, Caregiver and explained the purpose of the visit. Lorica Hipolito arrived at 11:01AM. The Administrator Felecia Hughes currently holds a certificate (#7000732740) that expires on 04/19/2027 per CCL portal.Felecia, Administrator gave Lorica, caregiver authorization to sign documents. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of five (5) bedrooms, two (2) bathrooms, one (1) bedroom occupied by staff. LPA did not observe any bodies of water. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 124.4 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and no skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last purchased on 02/27/2024. Emergency Disaster Plan was last posted on 04/02/2025. Fire drill was last conducted on 04/02/2025. First Aid kit was observed to be complete. Continue on LIC809C. Continued from LIC809 LPA reviewed five (5) resident records and four (4) staff records, and they were current and complete. LPA also reviewed the medication administration record (MAR) and medications during visit. LPA requested the following documents to be submitted to CCLD by 06/11/2025. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report (updated) LIC 610E Emergency Disaster Plan No deficiencies cited during visit. Exit interview conducted and a copy of this report provided to Lorica Hipolito.the state’s words, verbatim · CDSS document, Jun 4, 2025

Allegation investigated: Neglect resulting in resident developing pressure injury and hospitalization

On 03/28/2025 at 10:15 a.m., Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to deliver findings on the allegation above. The LPA informed Administrator, Lorica Hipolito of the reason for the visit. Allegation: Neglect resulting to resident developing pressure injury and hospitalization – Substantiated The Department's investigation included, but was not limited to, interviews with staff, home health nurse, home health director, and the Witnesses (W). The Department obtained and reviewed Resident’s (R1) hospital medical records and facility file. Continues on LIC9099-C1 . . . Substantiated R1’s after summary visit indicated that R1 wound was at a stage two but it was manageable. According to S1 observation R1 wound was on the merge of develop to a stage three, but it was manageable with preventative care. W3 advise the care staff to make sure to rotate the resident every two hours, and make sure to have some time for the resident to be air out. W3 came three time within a week, and the wound got worse. The staff keep on telling the family that the resident was doing better and getting better, but as a wound nurse the condition was getting worse. The family finally agree to send R1 to the hospital. During the interview process when care staff was asked why they didn’t call 911 if R1 condition was getting worsen. Care staff indicated that R1 family member didn’t agree for us to call 911 emergency, but contact the non-emergency. W2 and W3 observed that R1 was not being clean and observed R1 wound got worsen even though care staff claimed that had follow the advised that was given. W3 observed that R1 was being neglected and was left in solid diaper, and had reminded them many times and gave them multiples instruction, and as well as paper instruction. W2 observed that all the paper instruction was gone. From my experience as an RN if a resident was being taken care of as instructed the wound would not get worse and develop to a stage four. W1 stated “Yes, I believed that the facility takes go care of my mom, but in term of rotating my mom they were not doing as much as they were supposed to do. At the end we can see that my mom condition got worse. The facility never suggested that my mom would got worsen, until I was notified by the ACI nurse”. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC 9099-D. Exit interview conducted with Administrator Lorica Hipolito a copy of this report and appeal right was provided.the state’s words, verbatim · CDSS document, Mar 28, 2025 · control 15-AS-20240226151116

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.269(a)(6) · Plan of correction due date: Apr 7, 2025

1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (6) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on records reviewed and interviewed shows R1 wound was manageable at a stage 2 but develop to a stage 4 because S1 did not follow the care instruction by not rotating R1 every two hours, left R1 in solid diaper, also S1 did not let R1 wound air out prior to changing R1.the state’s words, verbatim · CDSS document, Mar 28, 2025

Plan of correction: Administrator agrees to review the citied section and self-certified the understanding the citied session, also conduct an in-service training on wound care. Administrator will start to record keeping of each residents on diaper changing, health care note, and time and date of personal hygiene and submit to CCLD by POC date.

Type of visit: Case Management - Legal/Non-compliance

On January 30, 2025 at 12:30 PM, Licensing Program Analyst (LPA) James Sampair conducted an unannounced case management visit to follow up on multiple substantiated allegations. LPA met with Caregiver Marvin Misa and explained the purpose of the visit. On May 9, 2024, the Department concluded a complaint investigation and substantiated the following five (5) allegations while a resident (R1) was under care: severe malnutrition, severe dehydration, developing pressure injury, developing a Urinary Tract Infection (UTI), and staff not seek medical attention in a timely manner. The Licensee was cited for violating the Health and Safety Code (HSC) Section 1569.269(a)(10) Enumerated Rights; California Code of Regulations (CCR), Title 22, Section 87464(f)(1) Basic Services, CCR, Title 22, Section 87615(a)(1) Prohibited Health Conditions; CCR, Title 22, Section 87466 Observation of the Resident; and CCR, Title 22, Section 87465 (a)(1) Incidental Medical and Dental Care. At the time of the complaint visit on May 9, 2024, an immediate civil penalty of $500 was issued. The licensee was informed that an additional civil penalty was still being determined and might be assessed based on Health and Safety Code § 1569.49. Continued on LIC 809-C . . . . . . Continued from LIC 809 The Department concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. Per Welfare and Institutions Code § 15610.67, serious bodily injury is defined as “an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the licensee’s failure to protect R1 from severe neglect which resulted in severe malnourishment and weight loss. R1 had an unstageable right ischial tuberosity pressure injury and was retained at the facility without proper medical care being provided. In addition, facility staff failed to provide adequate fluids to R1 which resulted in R1 being hospitalized for severe dehydration. R1 was severely dehydrated which contributed to R1 developing a UTI. Staff neglected to arrange and or assist in arranging appropriate medical care to the severe medical conditions and needs of R1. Today, January 30, 2025, the Department will be issuing a civil penalty per Health and Safety Code § 1569.49 for a violation that the Department constitutes as serious bodily injury in the amount of $10,000. However, since an immediate civil penalty of $500 was previously issued on May 9, 2024, the amount of the civil penalty today will be $9,500. A copy of the LIC 421D was given to Marvin Misa and originals were signed. Exit interview conducted. A copy of the report issued. Appeal Rights provided. Marvin Misa's signature on this report acknowledges receipt of the Appeal Rights, found on page two of LIC 421D.the state’s words, verbatim · CDSS document, Jan 30, 2025

Type of visit: Case Management - Legal/Non-compliance

On 01/09/2025 at 9:30AM, Licensing Program Analysts (LPAs) James Sampair and Tonica Syess-Gibson arrived unannounced to conduct a Case Management visit as a follow up to the 6/11/2024 Non-Compliance Conference with the Licensee Lorica Hipolito. Upon entry, the LPAs stated the purpose of the visit to the Licensee. The LPAs inspected the interior and exterior of the facility, including the kitchen, dining area, restrooms, community living spaces, resident rooms, storage areas, garage, and the grounds of the facility. There was a minimum of 7 days of nonperishable and 2 days of perishable foods at the facility. The water temperature was measured at 111.5 degrees, and the living room temperature was 75 degrees Fahrenheit. The fire extinguisher was last serviced on 02/27/2024. The carbon monoxide and smoke detectors were fully operational. The LPAs observed required postings in the facility, including the Residential Care Facility for the Elderly Complaint Poster, Ombudsman and Personal Rights posters, and the Theft and Loss Policy. The LPAs reviewed facility records and five (5) residents records they were all complete. No deficiencies cited during visit. Exit interview conducted, a copy of this report provided to Licensee, Lorica Hipolito.the state’s words, verbatim · CDSS document, Jan 9, 2025

Type of visit: Case Management - Legal/Non-compliance

On 11/14/2024 at 9:15 AM, Licensing Program Analysts (LPAs) James Sampair and Tonica Syess-Gibson arrived unannounced to conduct a Case Management visit as a follow up to the 6/11/2024 Non-Compliance Conference with the Licensee Lorica Hipolito. Upon entry, the LPAs stated the purpose of the visit to the Licensee. The LPAs met with Licensee to review her implementation of the Plan of How to Monitor Residents for Change of Condition the Licensee had submitted to the Department on 7/11/2024. The administrator, Felecia Hughes, hired on 7/11/2024 is on site 20 hours a week. However, the Administrator’s hours are not during business hours. The LPAs instructed the Licensee to change the hours to regular business hours (between 8:00 AM and 6:00 PM) and to ensure that the Administrator is overseeing the proper business operations. Licensee will send written plan to replace or change current Administrator hours by 11/21/2024 to LPA Tonica Syess-Gibson. The LPAs inspected the interior and exterior of the facility, including the kitchen, dining area, restrooms, community living spaces, resident rooms, storage areas, garage, and the grounds of the facility. The kitchen refrigerator was broken, and a replacement was ordered on 11/11/2024. Staff did not have the required minimum of 7 days of nonperishable and 2 days of perishable foods at the facility. At approximately 10:55 AM, the kitchen hot water temperature was measured at 137.2 degrees, and the living room temperature was 74 degrees Fahrenheit. The fire extinguisher was last serviced on 2/27/2024. The carbon monoxide and smoke detectors were fully operational. The LPA observed required postings in the facility, including the Residential Care Facility for the Elderly Complaint Poster, Ombudsman and Personal Rights posters, and the Theft and Loss Policy. The LPAs reviewed facility records and the records of 6 residents. 2 Type-A and 4 Type-B citations were issued during the inspection. Deficiencies are cited per Title 22 California Code of Regulations as listed on the LIC 809-Ds. $250.00 Civil Penalty assessed for repeat violation of Section 87303(e)(2). Failure to submit proof of corrections by plan of correction due dates may result in additional civil penalties. Exit interview conducted, a copy of this report, and the appeal rights were provided.the state’s words, verbatim · CDSS document, Nov 14, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Nov 15, 2024

87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F ... and not more than 120 degree F... This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above. The hot water was at 137.2 degrees Fahrenheit, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 14, 2024

Plan of correction: On or before the due date, the Licensee shall send proof to LPA Tonica Syess-Gibson that the temperature has been decreased to the safe range.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87705(f)(1) · Plan of correction due date: Nov 15, 2024

87705 Care of Persons with Dementia (RCFE) (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in the unlocked kitchen drawer with sharp knives, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 14, 2024

Plan of correction: Cleared during visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(26) · Plan of correction due date: Nov 21, 2024

87555 General Food Service Requirements (RCFE) (b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. Based on observation, the licensee did not comply with the section cited above. There was less than 7 days of non-perishable and 2 days of perishable food, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 14, 2024

Plan of correction: On or before the due date, the Licensee shall send pictures and receipts as proof to LPA Tonica Syess-Gibson that they have obtained the required amount of food for not only the date of purchase, but also enough so that when they make their next purchase they will still have 7 days of non-perishable and 2 days of perishable food on hand to feed the 6 residents at the time of the next food purchase.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87468.1(a)(3) · Plan of correction due date: Nov 21, 2024

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: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above with food that was kept in a locked drawer, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 14, 2024

Plan of correction: Cleared during visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 21, 2024

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees, and visitors. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above. The garage smelled of dog feces and urine, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 14, 2024

Plan of correction: On or before the due date, the Licensee shall send statement to LPA Tonica Syess-Gibson that the garage has been cleaned and is now odorless. Additionally, the Licensee shall make provisions that the floor of all areas within the facility have been cleaned of pet odors on a daily basis.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87705(c)(5)(A) · Plan of correction due date: Nov 21, 2024

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment ... and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. (A) When any medical assessment, appraisal, or observation indicates that the resident’s dementia care needs have changed, corresponding changes shall be made in the care and supervision provided to that resident. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above, with 3 of 6 residents had an out of date Physician's Report (LIC 602) and 0 of 6 Appraisal & Needs and Services Plans (LIC 625) for residents, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 14, 2024

Plan of correction: On or before the due date, the Licensee shall self-certify to LPA Tonica Syess-Gibson that a completed LIC 602 and LIC 625 is in each resident's file.

Type of visit: Required - 1 Year

On 5/14/24 at 10:30 AM, Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Lorica Hipolito and explained the purpose of the visit. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors, carbon monoxide detectors and fire extinguisher were in operating condition during visit. Emergency Disaster Plan was last posted on 7/22/23. First aid kit was observed to be complete. LPA reviewed 4 residents records and 3 staff records; all were complete. LPA also reviewed a sample of resident’s medications. THE FOLLOWING DEFICIENCY WAS OBSERVED: · The hot water temperature in the residents’ shared bathroom was measured at 140.1 degrees Fahrenheit. The above deficiency was observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiency by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. LIC809D, Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, May 14, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff did not ensure resident was fed resulting in resident becoming severely malnourished Staff did not monitor resident's water intake resulting in severe dehydration Resident developed a pressure injury while in care Resident developed a UTI while in care Staff did not seek medical attention for resident in a timely manner

On 5/9/2024 at 10:15 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to deliver findings on the allegations above. The LPA informed Licensee Lorica Hipolito of the reason for the visit. The Department's investigation included, but was not limited to, interviews with staff, residents, and the Reporting Party (RP). The Department obtained and reviewed Resident’s (R1) hospital medical records and facility file. R1 was admitted to the facility on April 22, 2020. Continues on LIC9099-C1 . . . Substantiated .... Continued from LIC9099 The complaint alleges that staff did not ensure the resident was fed, resulting in the resident becoming severely malnourished. Medical records from R1’s hospitalization on 8/15/2023 revealed a diagnosis of severe protein-calorie malnutrition and weight loss. Those records indicated a weight loss of 34 percent over 16 months, from 188 pounds on 4/6/2022 to 123 pounds on 8/15/2023. When interviewed, the 3 staff members, Administrator (ADM) Lorica Hipolito, Caregiver S1, and Caregiver S2, stated that they had observed R1's loss of weight and change in condition during that period. They stated that R1 had an irregular sleeping pattern. R1 was awake for as many as 3 days in a row, followed by as many as 3 days of sleep. When awake, they reported that R1 had a good appetite. When R1 was asleep, R1 was not fed by the staff. Their neglect resulted in severe malnourishment and weight loss for R1. The complaint alleges that staff did not monitor R1's water intake, resulting in severe dehydration. When interviewed, all the 3 staff members, ADM, S1, and S2, stated that R1 had an irregular sleeping pattern. R1 was awake for as many as 3 days in a row, followed by as many as 3 days of sleep. All 3 staff stated that R1 was diabetic and would drink lots of water when awake. When R1 was asleep, R1 was not given any fluids by the staff. Their neglect resulted in R1 going for as many as 3 days in a row without drinking any fluids. R1’s hospital medical records revealed that on 8/15/2023 R1 was diagnosed with severe dehydration, which resulted in R1 experiencing an altered mental state due to a metabolic encephalopathy caused by R1’s dehydration superimposed on a Urinary Tract Infection (UTI). The complaint alleges that R1 developed a pressure injury while in care. R1’s hospital medical records revealed that R1 was diagnosed with an unstageable right ischial tuberosity pressure injury on 8/15/2023. R1 did not have any other records with the hospital documenting a history of pressure injuries for R1. Interviews with ADM and S1 revealed consistent statements of having knowledge about R1's pressure injury. ADM admitted that R1 had a pressure injury on R1’s buttock that was difficult to locate. ADM and S1 had conflicting statements about the stage of R1’s right ischial pressure injury. ADM denied seeing R1's pressure injury at the size and stage of that for which R1 was diagnosed on 8/15/2023 at the hospital. Continues on LIC9099-C2 . . . .... Continued from LIC9099-C1 The complaint alleges that R1 developed a UTI while in care. R1’s hospital medical records revealed that on 8/15/2023, R1 was diagnosed with a Urinary Tract Infection (UTI). Medical records indicated that R1's UTI was a result of being malnourished and dehydrated. Interviews of ADM and S1 revealed inconsistent statements regarding R1's urine. ADM admitted observing R1 with discharge coming from R1’s penis about a week prior to R1 being transported to the hospital on 8/15/2023. ADM and S1 denied that R1 was in pain or needed assistance urinating. ADM and S1 denied that R1's urine had a foul odor or an unusual color. The complaint alleges that staff did not seek medical attention for R1 in a timely manner. R1’s hospital medical records revealed that on 8/15/2023, R1 was taken to the hospital by ambulance after the RP called 911. R1 was then diagnosed with dehydration, severe malnourishment, an unstageable right ischial pressure injury, and UTI. R1 was also diagnosed with experiencing an altered mental state due to metabolic encephalopathy caused by R1’s dehydration superimposed on R1’s UTI. Interviews with ADM and S1 revealed consistent statements of communicating R1’s change in condition with the RP and R1’s Primary Care Physician (PCP). ADM and S1 agreed that after communicating R1’s health with the RP and PCP, they did not take additional steps to address R1's declining health. ADM and S1 stated that R1's health was declining during 2023 and they failed to seek timely medical attention and that not seeking medical attention during that time resulted in the illnesses listed above. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC 9099-D. A $500.00 immediate civil penalty is assessed today. Licensee was informed that an additional civil penalty is still being determined based on Health & Safety Code 1569.49(f). Exit interview conducted with Licensee and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 9, 2024 · control 15-AS-20230922163356

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.269(a)(10) · Plan of correction due date: May 10, 2024

1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (10) To be free from neglect . . . This requirement is not met as evidenced by: Based on reviews of R1’s hospital medical records and interviews of Administrator Lorica Hipolito, S1, and S2, it was revealed that R1 was not fed by the staff on a regular basis, resulting in a medical diagnosis of severe protein-calorie malnourishment and weight loss on 8/15/2023, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 9, 2024

Plan of correction: A formal conference with CCLD will be scheduled at a later time.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: May 10, 2024

87464 Basic Services (f) Basic services shall at a minimum include … (1) Care and supervision as defined in … Health and Safety Code section 1569.2(c) … "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered… This requirement is not met as evidenced by: Staff members stated that R1 was not being given fluids for as many as 3 days in a row on a regular basis. From the 8/15/2023 hospital medical records, R1’s dehydration superimposed on a Urinary Tract Infection (UTI) resulted in metabolic encephalopathy causing R1 to experience an altered mental state. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 9, 2024

Plan of correction: A formal conference with CCLD will be scheduled at a later time.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: May 10, 2024

87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by: Based on reviews of R1’s medical records from their hospitalization on 8/15/2023, it was revealed that R1 had an unstageable right ischial tuberosity pressure injury. R1 was retained in the facility despite having that unstageable right ischial tuberosity pressure injury, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 9, 2024

Plan of correction: A formal conference with CCLD will be scheduled at a later time.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: May 10, 2024

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 reviews of R1’s hospital medical records, it was revealed that on 8/15/2023 R1 was diagnosed with a Urinary Tract Infection (UTI). Based on interviews of all staff members and a lack of facility documentation staff were not documenting changes to R1’s attention nor bringing those changes to the attention of the resident's physician and the resident's responsible person, if any, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 9, 2024

Plan of correction: A formal conference with CCLD will be scheduled at a later time.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: May 10, 2024

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: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. Based on reviews of medical records from R1’s hospitalization on 8/15/2023, R1 was diagnosed with dehydration, severe malnourishment, an unstageable right ischial pressure injury, a Urinary Tract Infection (UTI), and experiencing an altered mental state due to metabolic encephalopathy caused by R1’s dehydration superimposed on R1’s UTI. It was R1’s responsible person, and not the facility staff, who called 911 to get R1 to the hospital, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 9, 2024

Plan of correction: A formal conference with CCLD will be scheduled at a later time.

Type of visit: Case Management - Health Checks

On 2/27/2024, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a health check as a result of a Priority 1 complaint. Upon entry, LPA stated the purpose of the visit to administrator, Lorica Hipolito. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, garage and outdoor area. Facility temperature was maintained at 74 degrees F. More than the minimum of 7 days of non-perishable and 2 days of perishable food supplies were on hand. Resident medications were kept locked in the cabinet. Smoke and Carbon monoxide detectors tested and were functional. Fire extinguisher last purchased on 2/27/24. There are no accessible bodies of water observed. There is no deficiency noted on this day. Exit interview conducted and a copy of this report provided to administrator via email.the state’s words, verbatim · CDSS document, Feb 27, 2024