Grateful Heart Home Care

Type of visit: Case Management - Deficiencies

On 04/03/2026 Licensing Program Analyst (LPA) Raquel Hernandez conduncted an unannounced visit in regards to complaint 56-AS-20260401090418. LPA met with Assistant Administrator Ma Concepcion Choy. Administrator Charmaine Uy was unable to come to facility. LPA contacted Administrator Uy through telephone call. During visit, LPA observed a baby monitor from the brand "V-Tech" placed in resident's bedrooms. LPA observed there are (2) cameras monitoring with no audio for (2) residents in care. Administrator Charmaine Uy stated there is no recordings being kept as monitor does not keep recordings. Administrator Charmaine Uy stated an informed consent was signed by resident's responsible parties, however, LPA advised to Administrator Charmaine Uy a written request should have been submitted to licensing department. A deficiency will be issued. Based on the observations made during today’s visit, a deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) (LIC809D) was discussed and provided to Assistant Administrator Ma Concepcion Choy. Along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Apr 3, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87209(a)(2) · Plan of correction due date: Apr 6, 2026

(a) The use of alternate concepts, programs, services, procedures, techniques, equipment, space....(2) A written request for a waiver or exception and substantiating evidence supporting the request shall be submitted in advance to the licensing agency... Based on observation, the licensee did not comply with the section cited above by not ensuring a waiver request for video survelliance in private resident rooms was submitted to licensing department, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 3, 2026

Plan of correction: Licensee stated to remove cameras and does not wish to submit a waiver request. Licensee stated if in the future she chooses to use cameras a written request will be submitted.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) 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 Assistant Administrator Chantelle Fuka and was granted entry to the facility. Licensed capacity is (6) current census (6). LPA was accompanied by Assistant Administrator Chantelle Fuka 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 client 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 water temperature to test at 105 degrees Fahrenheit. 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 were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated office for resident/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care. 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. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed (3) resident medications. LPA also reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. No issues observed. 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 (LIC809) (LIC809C) was discussed and provided to Assistant Administrator Chantelle Fuka.the state’s words, verbatim · CDSS document, Mar 3, 2026

Allegation investigated: Facility did not provide resident transportation to medical appointments. Facility did not provide resident adequate care and supervision.

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Assistant Administrator Chantelle Fuka and explained the purpose of the visit. The investigation consisted of staff and resident interviews. For the allegation, Facility did not provide resident transportation to medical appointments LPA Hernandez conducted 3 resident interviews. 1 out of the 3 residents stated their family members help them with scheduling their medical appointments and with transportation. 2 out of the 3 residents stated the facility staff helps schedule their appointments and help with transportation. LPA Hernandez conducted (4) staff interviews. 4 out of the 4 staff stated residents have family that schedule and transport them to their appointments, while the other residents received help from staff and with transportation. Unsubstantiated For the allegation, Facility did not provide resident adequate care and supervision. LPA Hernandez conducted (3) resident interviews. 3 out of the 3 residents stated facility staff provides adequate care and supervision. Additionally, 3 out of the 3 residents stated facility staff help care for their personal needs. LPA Hernandez conducted (4) staff interviews. 4 out of the 4 staff stated they do provide adequate care and supervision to all residents in care and have not witnessed any staff not providing care or supervision. Based on the evidence gathered during today’s investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. During today’s visit, no deficiencies were cited pertaining to these allegations 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 Assistant Administrator Chantelle Fuka.the state’s words, verbatim · CDSS document, Mar 14, 2025 · control 56-AS-20220707102506

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) 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 Assistant Administrator Chantelle Fuka and was granted entry to the facility. Licensed capacity is (6) current census (6). LPA was accompanied by care giver Chantelle Fuka 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 client 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 water temperature to test at 112 degrees Fahrenheit. 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. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. LPA observed emergency disaster water and food to not be in same area and not prepared to gather in the case of an emergency diaster. LPA advised Assisted Administrator to put items in a container all together. Technical Assistance was given. There was a designated office for client/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed (3) resident medications. LPA observed residents medication to be transferred from original container to a different container. Deficiency will be issued. LPA also reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Additionally, LPA observed medications for all (3) residents to not be dated or signed in the Medication Administration Record (MAR). Deficiency will be issued. LPA also reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. No issues observed. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) (LIC809D) and (LIC9102) was discussed and provided to Assistant Administrator Chantelle Fuka. Along with the appeal rights.the state’s words, verbatim · CDSS document, Mar 14, 2025

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 care giver Chantelle Fuka and was granted entry to the facility. Licensed capacity is (6) current census (5). LPA was accompanied by care giver Chantelle Fuka 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 client 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. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. There was a designated office for client/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (3) client files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed (3) client medications. LPA also reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. During medication audit, LPA Rico observed 5 out of the 5 residents medications transferred were between containers. 5 out of the 5 resident medications were dispensed for a week. Based on the observations made 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 (LIC809) (LIC809D) was discussed and provided to care giver Chantelle Fuka. Along with the appeal rights.the state’s words, verbatim · CDSS document, Mar 15, 2024

Allegation investigated: -Neglect/lack of care and supervision resulted in the questionable death of the resident. -Neglect/lack of care and supervision resulted in the resident sustaining multiple unexplained injuries while in care.

This unannounced visit by Amy Goldenberg, Licensing Program Analyst (LPA), is being conducted to conclude this agency’s investigation into the complaint allegations mentioned above. During the course of the investigation, interviews were conducted with staff, a review of resident records was completed, and copies of pertinent documents obtained. Evidence collected pertaining to R1 included subpoenaed records from Vision Health and Hospice Care and Corona Regional Medical Center, review of the facility record on file with this agency, and of the record maintained by Grateful Heart Home Care for R1. Review of diaper change logs, narrative charting logs, Corona Regional Medical Center wound care report and emergency room records were reviewed. Additional investigation included text message correspondence between the reporting party and the facility staff. Investigation revealed the following: On 11/15/2021 R1 went to the hospital diagnosed with septic shock and severe pneumonia.(take out red) R1 died 4 days later at Coronal Regional Medical Center. Unsubstantiated It is alleged that the care provided to R1 resulted in their death. R1 was transported to the Emergency Department on 11/15/2021. She was admitted to the hospital on 11/16/2021. R1 passed away on 11/19/2021. The Coroner did not investigate her death. It is alleged that neglect/lack of care and supervision resulted in R1 sustaining multiple unexplained injuries while in care. R1 suffered an unwitnessed fall on 10/14/2021 and sustained an injury to their forehead. Facility staff were present in the room at the time of the fall but did not witness the fall. First aid was rendered but the facility staff did not seek medical attention for the head injury. Head injury is not listed as a cause of death. R1 did not have a history of falls at the facility and did not have any order for postural support while seated. R1 had a medical history of irregular bowl movement and it is not uncommon for R1 to go 3 to 4 days without a bowel movement. 911 was called on 11/15/2021. The facility staff report they did not observe any signs of immediate danger on 11/14/2021. We have found the complaint allegations are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. A copy of this report is being reviewed with and furnished to the facility representative. R1 suffered an unwitnessed fall on 10/21/2021 and sustained an injury to her for head. Staff were present in the room but did not witness the fall. The facility policy for an unwitnessed fall is to call 911. The facility staff did not call for emergency medical services. We have substantiated the complaint allegation as valid and that a violation has occurred based on the preponderance of available evidence. A copy of this report along with appeal rights are being reviewed with and furnished to the facility representative. Please see LIC 9099D.the state’s words, verbatim · CDSS document, Dec 15, 2023 · control 18-AS-20220118141100

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Dec 16, 2023

To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. The facility did not meet this requirement as evidenced by facility staff failing to seek immediate medical treatment by calling 911 for R1’s head injury from an unwitnessed fall on 10/21/2021. This poses a risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Dec 15, 2023

Plan of correction: Licensee to conduct staff training on facility policy, personal rights, and when to call for medical assessment. Statement of understanding from administrator and Licensee on regulation section cited.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Amy Goldenberg is conducting this case management visit to address deficiencies in conjunction with complaint control number 18-AS-20220118141100 which were discovered through investigation that were not part of the initial allegations. The facility failed to meet the reporting requirement regarding R1's fall on 10/14/2021 and subsequent death within the regulatory time frame. See LIC908D for deficiency cited. This report was reviewed with a copy was provided to the facility representative.the state’s words, verbatim · CDSS document, Dec 15, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Dec 16, 2023

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... The facility failed to meet the reporting requirement regarding R1's fall on 10/14/2021 and subsequent death within the regulatory time frame.the state’s words, verbatim · CDSS document, Dec 15, 2023

Plan of correction: Licensee to conduct training with all employees in reporting requirements and submit a statement of understanding of regulation section cited along with staff inservice sign in sheet.