Gracious Care Home

Allegation investigated: Staff are recording/video taping residents without consent.

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver the findings on the allegation listed above. LPA met with staff Ricardo Rojas Garcia and explained the purpose of today’s visit. The investigation consisted of staff interviews, resident interviews and record review. For the allegation, Staff are recording/videotaping residents without consent. During staff interviews 2 out of the 2 staff stated they do not take pictures or videos without resident consent. During resident interviews 3 out of the 4 residents stated staff have not taken pictures or videos of them. One resident was unable to collaborate on the allegation listed above. During record review, LPA observed residents, and their responsible party have approved for pictures or videos to be taken. Unsubstantiated Based on the evidence found during the investigation, the one (1) allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaint are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to staff Ricardo Rojas Garcia.the state’s words, verbatim · CDSS document, Feb 6, 2026 · control 56-AS-20260122161815

Type of visit: POC

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to the facility to verify clearance of Plan of Correction from visit on 1/28/2026. LPA Rico met with staff Ricardo Rojas Garcia and explained the purpose of the visit. The Licensee and the Administrator were not present at the facility. On 1/28/2026, the facility was cited on 1569.618(a). Today on 2/6/2026 LPA observed the facility did not have a designated manager. The Licensee Sandy Zhao was contacted and informed. Thirty minutes later, S2 arrived at the facility. S2 stated they are also the designated manager for more than three other facilities. At this time, the Plan Correction was not cleared. The facility will be issued a civil penalty of an amount of $900 for failure to correct. An exit interview was conducted and this reported (LIC809)(LIC421FC) was provided and discussed to staff Ricardo Rojas Garciathe state’s words, verbatim · CDSS document, Feb 6, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Mary Rico conduct an unannounced case managment pertaining to complaint control number 56-AS-20260122161815. LPA Rico met with staff Hilda A. Gutierrez and granted entrance to the facility. Upon arrival, LPA observed the Administrator, nor the designated House Manager was not present. During staff interviews, S1 confirmed that the facility did not have an Administrator nor House Manager present. In addition, during resident interviews 3 out of the 4 residents stated that S1 had been working for three weeks straight without additional staff members. A pervious licensing report was issued on 12/11/2025 giving the same violation. Because the facility has been cited for repeating the same violations within 12 months, an immediate civil penalty of $250.00 will be assessed. Based on the observations made during today’s visit, (1) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809)(LIC809D)(LIC421FC) and Appeal Rights was discussed and provided caregiver Hilda Gutirrez.the state’s words, verbatim · CDSS document, Jan 28, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.618(a) · Plan of correction due date: Jan 29, 2026

(a) The administrator designated by the licensee .. A facility manager designated by the licensee.. shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility.This requirement is not met as evidenced by: Based on observation, interview, and record review , the licensee did not comply with the section cited above by not having an Administrator nor facility manager present which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: The Licensee stated they will send an updated LIC500 for the deisgnated House Manager. POC due date 1/29/2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with caregiver Hilda A. Gutierrez and was granted entry to the facility. The Administrator Brandon Gutierrez was contacted and informed about today’s visit, the Administrator stated they were at their other facility, Green Merrylands (361880543) and were unable to leave. Based on record review, Administrator Brandon Gutierrez is also listed as the designated Administrator at Green Merrylands. LPA was accompanied by caregiver Hilda A. Gutierrez, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. During facility tour, LPA Rico observed R1/R2 had cleaning solution located under resident’s bathroom cabin without a lock. Cleaning solution was immediately removed. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents . Dishes, cups, and utensils were also stored properly. Care & Supervision The facility did not have an Administrator or a designated House Manager present on the premises. The Administrator stated that they were unable to come to the facility. Based on a review of records, LPA observed that the facility’s LIC 500 listed the Licensee as Sandy Zhao, the Administrator as Brandon Gutierrez, and two-House Managers, Osvaldo Nunes and Titus Kaue. None of the listed individuals were present at the facility during the visit. During staff interviews, S1 stated both house managers were on vacation. Record Review: LPA reviewed (4) resident file for admission agreements, updated physician reports, and needs and services plans. LPA also verified (4) resident's medications. LPA also reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screening. Based on the observations made during today’s visit, (2) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809)(LIC809) and Appeal Rights was discussed and provided caregiver Hilda Gutirrez.the state’s words, verbatim · CDSS document, Dec 11, 2025

Allegation investigated: Due to lack of care and supervision resident sustained a pressure injury.

Licensing Program Analyst (LPA) Mary Rico conducted unannounced visit to deliver findings for the allegations listed above. LPA met with Administrator Brandon Marquezand explained the purpose of the visit. The investigation conducted by Department staff consisted of staff, resident interviews and review of pertinent records. Allegation, Resident developed a pressure injury due to staff neglect. Evidence shows that R1 sustained a Stage 4 pressure injury on sacrum. However, the wound developed prior to R1 moving into the facility. Evidence show that R1 sustained a Stage 4 pressure injury on Sacrum prior to being placed at Gracious Care Home. Evidence shows that R1was receiving wound care services from Home Health. In addition, Licensed Vocational Nurse (LVN) confirmed they would visit R1 and provided wound care along with catheter care. During staff interviews 2 out of the 3 staff stated R1 was receiving wound and catheter care from Home Health. Unsubstantiated Based on the evidence gathered during today’s investigation, the one (1) allegation listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegation are valid because the preponderance of evidence the standard has been met. During today’s visit, one (1) deficiency were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and LIC9099D was discussed and provided to Administrator Brandon Marquez along with a copy of the appeal rights. Based on the evidence found during the investigation, the one (1) allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Brandon Marquez.the state’s words, verbatim · CDSS document, Jun 20, 2025 · control 56-AS-20241204090408

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Jun 23, 2025

87411(a)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 based on interview and document review, the licensee did not comply with the section cited above evidenced by failing to seek medical attention in a timely manner for R1, which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 20, 2025

Plan of correction: The licensee has agreed to conduct a staff training for proper emergency procedures and send LPA proof of staff attendance POC due date 6/23/2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to conduct a Health and Safety check of the clients in care at the facility. LPA Rico met with Administrator Brandon Gutirrez explained the reason for the visit. The Health and Safety check included overall observation of the facility inside, and outside, including food supply, medications, physical plant, and the clients in care. LPA Rico did not observe any safety hazards. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Administrator Brandon Gutirrez.the state’s words, verbatim · CDSS document, Jun 20, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to the facility to verify clearance of Plan of Correction from visit on 3/21/2025. LPA Rico met with Administrator Brandon Marquez and was granted entry to the facility. The following deficiencies were not cleared during the time of the visit: The Licensee was cited on 3/21/2025 for 87458(a) Medical Assessment . During today's visit, based on record review, observation and interview, LPA Rico observed that the Licensee did not have send LPA R1 medical assessment. The Plan of Correction was to send LPA Rico R1 Medical Assessment. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for four (4) days. The following deficiencies were cleared during the time of the visit. In addition, on 3/21/2025 the facility was for 874655(c)(3) Incidental Medical and Dental Care Services for not documenting PRN medication properly that included the date, time and resident response. LPA Rico observed the Administrator had created an in-service training for staff. The Plan Correction was cleared and a copy of clearance letter was provided to Administrator. An exit interview was conducted and this report, LIC809 along with Civil Penalty Assessment pages, and Appeal Rights were reviewed and provided to Administrator Brandon Marquez .the state’s words, verbatim · CDSS document, Apr 1, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to conduct a Health and Safety check of the residents in care at the facility. LPA Rico met with caregiver Carmen Guadalupe Rodriguez Olague and explained the reason of the visit. Licensee Sandy Zao was contacted along with Administrator Brandon Marquez. Both indicated they were unavailable to be at the facility. During facility tour, LPA Rico observed the facility did not have an Administrator or designated substitute on facility premises. In addition, S1 and S2 stated they are not the manager nor Administrator. A previous licensing report was issued on 10/16/2024 giving notice of the same violation. Because the licensee has been cited for repeating the same violation within 12 months, the following civil penalty shall be assessed until the violation is corrected. Furthermore, LPA Rico observed the facility did not have one (1) out of the three (3) residents Physician Report LIC602A. During medication audit, LPA Rico observed the facility did not document R2 PRN response/result. Based on the observations made during today’s visit, three (3) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) (809D) (LIC421FC7/17) was discussed and provided to caregiver Osvaldo Nunes Aldrete. Along with a copy of appeal rights.the state’s words, verbatim · CDSS document, Mar 21, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: Mar 28, 2025

87458(a) Medical Assessment Prior to a person's acceptance.. the licensee shall obtain and keep on file.signed by a physician, made within the last year. Physician's Report, to obtain the medical assessment.This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by not having a R1 LIC602 which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 21, 2025

Plan of correction: Licensee stated they will obtain a copy of R1 LIC602 and will also send a copy to LPA Rico. POC due date 3/23/2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(3) · Plan of correction due date: Mar 24, 2025

Incidental Medical and Dental Care Services 87465(c)(3)A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. Based on medication audit 1 out of the 3 residents did not have their PRN documented properly. The licensee did not comply with the section cited above which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 21, 2025

Plan of correction: The Licensee stated she will train all caregivers on the regulation cited above and will send LPA a copy to LPA Rico. POC due date 3/24/2025

Type of visit: POC

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to the facility to verify clearance of Plan of Correction from visit on 12/11/2024. LPA Rico met with caregiver Danielle Camila Romero Hernandez and was granted entry to the facility. During today's visit, Administrator Brandon Marquez Gurtierrez was not present at the facility. LPA Rico and staff Danielle Camila Romero Hernandez attempted to contact Administrator Brandon Marquez Gutierrez. The following deficiencies were not cleared during the time of the visit: The Licensee was cited on 12/12/2024 for 87509(d) Resident Records(d) . During today's visit, based on record review, observation and interview, LPA Rico observed that the Licensee did not have send LPA R2 records. The Plan of Correction was to send LPA Rico R2 records. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for eight (8) days. In addition, On 12/05/2025 the facility was cited for 87355 Criminal Record Clearance (e) for having S1 working without a criminal record clearance. On 12/11/2024 was cited for failure to correct The Plan of Correction. Today on 12/20/2024 LPA Rico observed S1 is still working at the facility without a criminal record clearance. An exit interview was conducted and this report, LIC809 along with Civil Penalty Assessment pages, and Appeal Rights were reviewed and provided to caregiver Danielle Camila Romero Hernandez.the state’s words, verbatim · CDSS document, Dec 20, 2024

Type of visit: POC

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to the facility to verify clearance of Plan of Correction from visit on 12/15/2024. LPA Rico met with caregiver Martiza A Mendoza and was granted entry to the facility. During today's visit, Administrator Brandon Marquez was contacted and informed of the visit. The following deficiencies were not cleared during the time of the visit: The Licensee was cited on 12/5/2024 for 87355 Criminal Record Clearance (e). During today's visit, based on record review, observation and interview, LPA Rico observed that the Licensee did not have an updated LIC500. The Plan of Correction was to send LPA Rico proof of facility LIC500. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for five (5) days. An exit interview was conducted and this report, LIC809 along with Civil Penalty Assessment pages, and Appeal Rights were reviewed and provided to caregiver Martiza A Mendoza.the state’s words, verbatim · CDSS document, Dec 11, 2024

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to the facility to verify clearance of Plan of Correction from visit on 12/15/2024. LPA Rico completed a case management visit to cite for deficiencies found during the facility visit. During today's visit, Administrator Brandon Marquez was contacted and informed of the visit. During record review, LPA observed R1 and R2 records were missing. S1 informed LPA that R2 is a new resident and official move in date was 11/28/2024. S1 admitted the facility did not have R1 and R2 record file at the facility. S1 also stated that the facility no longer has R2 file at the facility, and no copies to provide LPA. Furthermore, based on interview and observed the facility did not have an Administrator or designated substitute on facility premises. A previous licensing report was issued on 10/16/2024 giving notice of the same violation. Because the licensee has been cited for repeating the same violation within 12 months, the following civil penalty shall be assessed until the violation is corrected. In addition, LPA observed S1 did not have a CPR certificate and was the only staff on premises. A previous licensing report was issued on 10/16/2024 giving notice of the same violation. Because the licensee has been cited for repeating the same violation within 12 months, the following civil penalty shall be assessed until the violation is corrected. An exit interview was conducted and this report, LIC809 along with Civil Penalty Assessment pages, and Appeal Rights were reviewed and provided to caregiver Martiza A Mendoza.the state’s words, verbatim · CDSS document, Dec 11, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 1569.618(b) · Plan of correction due date: Dec 12, 2024

(b) At least one administrator, facility manager, or designated substitute who is at least .. Title 22 ... the premises 24 hours per day... The designated substitute shall meet qualifications that include, but are not limited to, all of the following... Based on observation and interview , the licensee did not comply with the section cited above by not having a designated substitiute that meets qualifications present which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 11, 2024

Plan of correction: Administrator stated they will send a copy of their designated substitutes along with their work schedule. Administrator also stated the Licensee will ensure the facility has a designated present on premises 24hours. POC due date 12/12/2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR87509(d) · Plan of correction due date: Dec 12, 2024

87509(d)Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: Based on observation and interview , the licensee did not comply with the section cited above by not having a R1 and R2 records at the facility an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 11, 2024

Plan of correction: Administrator stated they will send LPA Rico R2 records. POC due date 12/12/2024

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.618(c)(3) · Plan of correction due date: Dec 12, 2024

1569.618(c)(3) Administration.. qualifications; (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 requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above, S1 did not have a CPR card which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 11, 2024

Plan of correction: Administrator stated they will enroll S1 to a CPR class and will send proof to LPA. Licensee also stated they will send a copy of all staff CPR. POC due date 12/12/2024

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Mary Rico met with caregiver Danielle Camila Romero Hernandez to initiate case management visit. The Administrator Brandon Marquez was also contact regarding today's visit. During record review, LPA Rico review staff criminal record clearance. LPA Rico observed S1 did not have a criminal record clearance.In addition, the Administrator and S1 stated they have not received their criminal record clearance. S1 stated the have been working at the facility since 11/28/2024. During today’s visit the facility a deficiency will be issued and Civil Penalties were assessed with the amount of $500.00 for S1 An exit interview was conducted where this report (LIC809), (LIC809D), (LIC421BG) and Appeal Rights were discussed and provided to caregiver Danielle Camila Romero Hernandez and caregive Osvaldo Nunes Aldrete.the state’s words, verbatim · CDSS document, Dec 5, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Dec 6, 2024

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: (1) Obtain a California clearance... This requirement is not met as evidenced by: Based on observation and interview, the Licensee did not comply with the section cited above by not obtaining Staff #1 (S1) criminal record clearance before allowing S1 to work at the facility since 11/28/2024 which pose immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 5, 2024

Plan of correction: Licensee stated to not allow S1 to work at the facility without obtaining the required Criminal background clearance and submit copy of Staff Schedule and Personnel Summary Report (LIC500) to LPA Rico at Plan of Correction due date. POC due date 12/6/2024

Type of visit: POC

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to the facility to verify clearance of Plan of Correction from visit on 10/16/2024. LPA Rico met with staff Osvaldo Nunes Aldrete and was granted entry to the facility. During today's visit, Licensee Sandy Zhao and House Manager Brandon Marquez were contacted and informed of the visit. The following deficiencies were not cleared during the time of the visit: The Licensee was cited on 10/16/2024 for 1569.618(b) Other Provisions. During today's visit and based on record review, observation and interview, LPA Rico observed that the Licensee did not have a designated substitute present and the Administrator present. The Plan of Correction was to send LPA Rico proof of their designated substitutes along with their work schedule. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for eight (8) days. The Licensee was cited on 10/16/2024 for 87303(a)Maintenance and Operation. During today's visit, LPA Rico observed kitchen cabins to be dirty. The Plan of Correction was for Licensee to clean kitchen cabins and send proof to LPA Rico. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for eight (8) days. The Licensee was cited on 10/16/2024 for 87303(d)Maintenance and Operation. During today's visit, LPA Rico observed the Licensee did not fix the hallway lights. The Plan of Correction was for Licensee to send proof the hallway lights have been fixed. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for eight (8) days. The Licensee was cited on 10/16/2024 for 87303(e)(3) Maintenance and Operation During today's visit based on record review, observation and interview, LPA Rico observed the Licensee did not have warning signs for hot water. The Plan of Correction was to send LPA proof the Licensee has posted warning signs on resident's bathrooms. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for eight (8) days. The Licensee was cited on 10/16/2024 for 1569.618(c) Other Provisions. During today's visit based on record review, observation and interview, LPA Rico observed the Licensee did not update the LIC500. The Plan of Correction was to send LPA a copy of the updated LIC500. enroll S1 to a CPR class and will send proof to LPA. Licensee also stated they will send a copy of all staff CPR. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for eight (8) days. The Licensee was cited on 10/16/2024 for 1569.618(c)(3) Other Provisions. During today's visit based on record review, LPA Rico observed S1 was the only staff present and did not have a CPR card. The Plan of Correction was for enroll S1 to a CPR class and will send proof to LPA. Licensee also stated they will send a copy of all staff CPR. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for eight (8) days. The Licensee was cited on 10/16/2024 for 87355(e)(3) Criminal Record Clearance. During today's visit based on record review, LPA Rico review the facility did not transfer S1 criminal clearance to be associated to the facility. The Plan of Correction was to send LPA Rico proof S1 criminal clearance is associated to the facility. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for eight (8) days. The Licensee was cited on 10/16/2024 for 87465(d)(3) Incidental Medical and Dental Care Services. During today's visit based on record review and interviews. LPA verify no staff training was conducted. The Plan of Correction was for the Licensee to train all staff on the regulation cited and send proof to LPA.Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for eight (8) days. The Licensee was cited on 10/16/2024 for 87465(e)Incidental Medical and Dental Care Services. During today's visit LPA verify R1 medications were not listed on file. The Plan of Correction was for the Licensee to have R1 medications listed on file. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for eight (8) days. The Licensee was cited on 10/16/2024 for 87705(c)(5)Care of Persons with Dementia. During today's visit, LPA Rico observed R2 did not have their medical assessment and no appointment was schedule. The Plan of Correction was for Licensee to send proof to LPA Rico the Licensee had schedule a medical assessment for R2. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for eight (8) days. The Licensee was cited on 10/16/2024 for 87705(j) Care of Persons with Dementia. During today's visit based on record review,and interviews LPA Rico verify no staff training were conducted. The Plan of Correction was for the Licensee to send proof to LPA they train their staff on the regulation cited. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for eight (8) days. The Licensee was cited on 10/16/2024 for 87208(a)Plan of Operation. During today's visit, based on record review LPA did not observed the Plan of Operation in facility file. The Plan of Correction was to send LPA proof where the plan of operation will be located at the facility. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for four (4) days. The Licensee was cited on 10/16/2024 for 87303(c) Maintenance and Operation. During today's visit, based on observation LPA verify the window screen has not been replaced. The Plan of Correction was to replaced the window screen. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for four (4) days. The Licensee was cited on 10/16/2024 for 87311 Telephones. During today's visit, LPA Rico tested facility phone. The facility phone is still out of service. The Plan of Correction was to fix facility and send proof to LPA Rico. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for four (4) days. The Licensee was cited on 10/16/2024 for 1569.618(c)(4)Other Provisions. During today's visit, LPA Rico observed the electric wires in the hallway have not been fixed. The Plan of Correction was to fix the wires and send proof to LPA Rico. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for four (4) days. The Licensee was cited on 10/16/2024 for 87219(a)Planned Activities. During today's visit, LPA observed the facility did not have activities calendar. The Plan of Correction was send to send LPA Rico a copy of activities calendar and train their staff on the regulation cited. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for four (4) days. The Licensee was cited on 10/16/2024 for 87465(a)(8)Incidental Medical and Dental Care Services. During today's visit, LPA Rico observed the facility did not a completed first aid kit. The Plan of Correction was to send proof the facility first aid kit had all the supplies contain. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for four (4) days An exit interview was conducted with staff Staff- Osvaldo Nunes Aldrete where this report, LIC809 along with Civil Penalty Assessment pages, and Appeal Rights were reviewed and provided.the state’s words, verbatim · CDSS document, Oct 25, 2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Mary Rico and Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with caregiver Karim Morales and was granted entry to the facility. The facility is a (5) bedroom, (3), bathroom home and, with a kitchen/dining area, living room and attach garage. Licensed capacity is (6) current census (2). LPAs were accompanied by caregiver Karim Morales to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. The facility is equipped with operating carbon monoxide alarms and fire alarms. Posters such as personal rights, the CCL complaint poster, in the common area.Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Deficiencies that were found during facility tour: LPAs inspected residents’ bedrooms; R1 and R2 had mattresses, nightstands, storage space, but did not have chairs. During facility tour, LPAs observed two electric wires hanging off of the wall by residents’ bedrooms, this is fire hazard for residents in care. R1 and R2 did not have non-skid mats inside their bathroom tub. LPAs tested residents’ water; the temperature tested at 126 F. No cautions warning signs posted. In addition, during facility tour, LPAs observed the facility kitchen hallway, living area, resident’s hallways and (2) resident’s bedrooms did not have light installed nor lamps for appropriate lighting. LPAs inspected kitchen cabinets, (8) kitchen cabinets were dirty, with food crumbs and dirt. Furthermore, LPAs observed the window located by the dining area did not have a window screen install. LPAs and S1 tested facility phone, the phone was out of service. During facility tour, R1 and R2 bathroom was not free from incontinence odor. Next, LPAs tested exit monitor device for residents with dementia. The devices were turned off. The facility currently has (1) dementia residents, facility must always remain devices on. In addition, no activities were provided during inspection and the facility did not have activities listed for the residents. Lastly, LPA observed the facility did not have their First Aid Kit completed and did not have the American Red Cross Manual current edition. Delicacies that were found during record review: LPAs observed the facility did not have their Plan of Operation in their facility file and no Disaster Plan 610. In addition, R1 did not have their hospice care plan in file, and R2 did not have their annual medical assessment which is required for dementia resident. Furthermore, R1 did not have (1) of their medication listed on their MAR and did not have their PRN documented with the time, date, and resident response. Lastly, during criminal record clearance check, LPAs observed S1 is not associated to the facility. The licensee was advised to submit transfer request. Deficiencies that were found during care & supervision: The facility does not have sufficient staff coverage, based on the LIC500 the staff members that were scheduled were not present. During staff interview, S1 stated they will be working over 24 hours. During facility annual inspection, the facility did not have a designated staff present, house manager or Administrator present. Moving forward the licensee shall ensure the facility has designated staff present or Administrator present for 24 hours as stated in Tittle 22 Regulations. Based on observations today, a civil penalty in the amount of $500.00 dollars will be issued for not transferring S1 criminal record clearance. The facility will be issued (11) Type A deficiencies and (12) Type B deficiencies per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed to Licensee Sandy Zhao on the phone and was provided to caregiver Karim Ibarra Morales along with a copy of LIC809D, LIC421BG, and the appeal rights.the state’s words, verbatim · CDSS document, Oct 16, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to deliver amended finding on complaint control number: 56-AS-20220621092755. LPA met with facility staff Vicente Picache and was informed of the reason for the visit. Findings for the allegations remain as UNSUBSTANTIATED. The report was discussed with Mr. Picache and copies of this report and amended findings (LIC9099) were provided to Mr. Picache at the conclusion of today’s visit.the state’s words, verbatim · CDSS document, Mar 11, 2024

Allegation investigated: Staff hit resident in care

This unannounced visit by Amy Goldenberg, Licensing Program Analyst (LPA), is being conducted to conclude this agency’s investigation into the complaint allegation mentioned above. During the course of the investigation, interviews were conducted, and a review of resident records was completed. On 04/06/2023 it was alleged that facility staff hit R1 on the back of the head daily resulting in a bump on the back of their head. A specific staff is not identified. Two resident interviews were conducted. Two out of two residents interviewed could not provide any information regarding physical abuse due to cognitive status. LPA interviewed S1. S1 is the primary caregiver of the facility at this time. S1 denies having hit R1 on the back of the head. Interview with R1's responsible party revealed that R1 had the bump on the back of the head following a medical event in August 2022 and there is no observable change to the bump. Unsubstantiated R1 moved into this facility December 2022. Based on the available information through interviews we have found the complaint allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and furnished to the facility representative.the state’s words, verbatim · CDSS document, Dec 14, 2023 · control 56-AS-20230406152853

Allegation investigated: Resident's were denied visitors while in care. Resident's care needs are not being met while in care.

Licensing Program Analyst (LPA) Anna Bueno conducted a subsequent visit on this day to deliver an amended report to the above-mentioned complaint allegations. LPA Amy Goldenberg completed the visit on 12/12/2023. Findings for the allegations are still unsubstantiated. During the course of the investigation, interviews were conducted, a review of resident records was completed and copy of pertinent documents obtained. It is alleged that Licensee Sandy Zhao and an unknown staff denied a family member visitation with R1. Investigation revealed the following information: Interview with the reporting party revealed that on 06/20/2022 a visitor attempted to visit R1 and the facility staff would not allow the visitor access into the home and law enforcement was called to gain access. There are no court orders preventing anyone visitation with R1. Unsubstantiated Interview with the house manager confirmed that R1's visitor called law enforcement to the home. The house manager and licensee both deny not granting the visitor to see R1, however, the visitor refused to follow COVID protocols in place at that time of Covid vaccination or rapid testing results and/or masking. The house manager and licensee claim that attempts were made to accommodate the visit. All parties report that the visitor was able to see R1 after a solution was reached. It is alleged that R1's care needs are not being met. Investigation included review of R1's record, interview with witness and facility staff. LPA toured the facility and made observation of residents in care. LPA did not observe any signs that two (2) of two (2) residents are not being cared for. One witness interviewed reports that the care their family member has received has been good. Interviews and review of R1's available record does not reveal any information to conclude that a violation occurred. Based on the aforementioned, we have found the complaint allegations unsubstantiated. Although the alleged violations may have occurred or are valid, there is not a preponderance of evidence to prove that a violation occurred. This report was reviewed with and a copy was provided to the facility representative.the state’s words, verbatim · CDSS document, Dec 12, 2023 · control 56-AS-20220621092755

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Goldenberg arrived at 0845 unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. LPA began review of resident records. Two (2) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. R2 is missing a physician's order for 1/2 bedrails. LPA observed two 1/2 rails on the bed of R2. Resident Rights are posted in the facility and a copy is signed on file. Dementia and hospice regulation requirements are being met. LPA began review of employee records. Three (3) records were reviewed. LPA reviewed employee record for first aid certification, finger print clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. LPAs observe the facility to be clean and in good repair. The home is maintained at a comfortable temperature for the residents. Lighting is sufficient for safety and comfort. Water temperature measured 107 degrees F. Grab bars, non slip mats are present in the restrooms. Laundry facilities tour revealed bleach and laundry soap unlocked and accessible to residents. Fire extinguishers are charged, mounted and current. All outdoor and indoor passageways are free of obstruction. Night lights and emergency lighting is present. A locked area is provided for medications, however, LPA observed that the medication cabinet lock does not prevent access to others. LPA was able to open the medication cabinet. It is only secured with a baby type device and is easily opened by non employees and residents. There is a telephone working at this location. The LIC 610E, emergency disaster plan is maintained. The facility has a current written definitive plan of operation. Review of resident records revealed that the facility is not in compliance with their approved fire clearance. R2 is identified on their physicians report ad bedridden. This facility does not have a bed ridden fire clearance. Personnel Records/Training/and Staffing- LPA reviewed two employee records for CPR and annual training requirements. To assess if the facility employs enough staff to maintain cleanliness and meet the needs of the residents in care. Administrator certification is present. There are no training records available to review. The facility retains residents with dementia and require awake staff at night. There are no scheduled awake staff present to meet the requirement. Food Service- LPA were present during the breakfast and lunch time meal. The meal is adequate to meet the nutritional needs of the residents. Food prep areas are clean and organized. Food supply meets the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. Two client interviews were attempted. One Staff interview was conducted. Based on the information received during this visit today, the following deficiencies are being cited per Title 22, Division 6 of The California Code of Regulations. This report was reviewed with and a copy provided to the facility representative. Appeal Rights were also provided at the time of the exit interview. See also LIC 809D.the state’s words, verbatim · CDSS document, Oct 12, 2023