Grove St Care Home

Type of visit: Required - 1 Year

On 07/20/2026, Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to rewrite the annual visit that occurred on 04/22/2026. Due to technology errors, the report did not replicate and showed the annual was never completed. LPA Valerio obtained a copy of the report, which was left with Administrator Manual on 04/22/2026. The report read as mentioned below: "Licensing Program Analyst (LPA) Christina Valerio and LPA Reza Jamaly arrived unannounced to conduct an annual required inspection. LPAs met with facility staff Vilma and Administrator Manual Alberto Sandoval, and explained the purpose of the visit. LPAs and facility staff toured the facility to ensure compliance with Title 22 regulations. LPAs observed resident bedrooms to be fully furnished, free from odors, and without obstruction to exit doors. LPAs observed two resident bathrooms, which was observed to have a trash can, hand rail, skid matts, shower chair, and hygiene supplies. LPA observed common areas to be fully furnished and organized. Resident were observed sitting in the living room or in their bedroom. Staff were observed preparing meals and assisting residents in care. The backyard was observed to have a large walkway for residents, a sitting area, and a garden area. The kitchen was observed to have medications, sharps, and toxins locked and inaccessible to residents in care. The facility was observed to have an adequate food supply along with an emergency supply of food and water. Fire extinguisher, carbon monoxide detector, and fire pull alarms system were observed to be in working condition. No health or safety were observed. The date of the last fire annual inspection for the fire extinguisher was May 13, 2025. LPAs observed resident and staff files. All files were observed to be up to date with required documentation. LPAs requested the following be sent to ascpcclsacramentosouthRO@dss.ca.gov:LIC 500, LIC 308, LIC 610, and copy of liability insurance." Per California Code of Regulations (CCR) Title 22, no deficiencies were cited on 04/22/2026 and on today's date of 07/20/2026. An exit interview was held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 20, 2026

Allegation investigated: Staff are physically/verbally abusing resident. Staff did not seek medical attention in a timely manner

On 5-13-2026 at 1:00pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue investigation for the allegations noted above. LPA met with Administrator Manuel Sandoval and explained the purpose of the visit. LPA conducted additional interviews with three residents in care as part of this continuing investigation. The full investigation consisted of other interviews with four staff members as well as facility file documentation review of physician's report, medication log sheets, needs and service plan, incident reports, medical records, and additional text messages submitted by licensee pertaining to resident1(R1). Additionally, LPA conducted facility observation on 5-13-2026. Allegation: Staff are physical/verbally abusing resident. LPA conducted interviews and record reviews as noted above. Based on interviews conducted, there is no corroborated statements or evidence to prove resident1 (R1) or other residents in care have been physically or verbally abused by staff. LPA observed during a visit on 5-13-2026 staff assisting residents appropriately and timely including providing meals and other care needs. {Cont. on 9099C} Unsubstantiated Interviews conducted with residents and staff revealed staff interactions as adequate and meeting the needs of residents in care. LPA did not observe any red marks or other types of bruising on residents in care during the observation. Documentation review indicated resident1 (R1) was admitted to facility with a diagnosis of Schizophrenia. Additional documentation review revealed no further evidence of physical or verbal abuse towards residents. An interview with R1 did not reveal conclusive evidence of staff physically or verbally abusing resident in care. As a result, there is not a preponderance of evidence to conclude staff have physically or verbally abused any residents in care, therefore, this allegation is UNSUBSTANTIATED. Allegation: Staff did not seek medical attention in a timely manner. LPA conducted interviews and record reviews as noted above. Based on these interviews and record reviews, it was revealed that on or about 3-25-2026, resident1 (R1) was experiencing chest congestion and weakness. As a result, staff on duty called 911 for assistance and R1 was admitted to a local hospital for further treatment and diagnosed with pneumonia and slow heart rate. Additional review of text messages between Administrator and responsible party indicate that on 3-25-2026, a communication was made by Administrator to responsible party to inform of R1's symptoms and need for 911 services performed. Additional interviews and record reviews further revealed R1's history of pneumonia and need for hospitalization, and staff response in an adequate and timely manner. Additional interviews revealed staff in general has met residents' needs in a timely and adequate manner with no corroborated evidence to the contrary. As a result, there is not a preponderance of evidence to conclude staff did not seek medical attention in a timely manner, therefore, this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Administrator and a copy of this report was provided. Appeal rights provided.the state’s words, verbatim · CDSS document, May 13, 2026 · control 27-AS-20260401103505

Type of visit: Case Management - Other

On 5-13-2026 at 3:26pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding medication review. LPA met with Administrator Manuel Sandoval and explained the purpose of the visit. LPA conducted a medication log review as part of an investigation for complaint #27-AS-20260401103505. During review of medication log sheets for resident1 (R1) dated March 2025, it was indicated that multiple medications were not dispensed on multiple days. LPA's review of bubble packs could not conclude medications were given. The medication log sheets contained multiple blank spots designated for signatures on these multiple medications. As a result of today's case management, citation is issued under Title 22, Division 6 and noted on LIC 809D. An exit interview was conducted with Administrator and a copy of this report was provided. Appeal rights provided.the state’s words, verbatim · CDSS document, May 13, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: May 14, 2026

87465 Incidental Medical and Dental Needs. (1) (a) A plan for incidental medical and dental care shall be developed by each facility...(4) The licensee shall assist residents with self administered medications as needed. This requirement was not met as evidenced by: Based on record review, licensee did not ensure the assistance of self administered medication for R1 on multiple days during March 2025. This posed an immediate health and safety risk to resident in care.the state’s words, verbatim · CDSS document, May 13, 2026

Plan of correction: Licensee will ensure completed training on medication documentation and accountability. Training to be completed by an outside vendor. Training date to be submitted to LPA by POC due date with proof of completed training to be sent to LPA no later than 5-27-2026.

Type of visit: Required - 1 Year

Licensing Program Analyst(s) (LPA) Victoria Brown and Sommer Hayes arrived unannounced to conduct a Required - 1 Year visit on 3/14/25 at 12:30pm. LPAs observed the Administrator Certificate expires 8/12/26. LPAs met with Manuel Sandoval, Administrator and stated the purpose of todays visit. The facility is licensed for a capacity of 6 non-ambulatory residents of which 2 may receive hospice care services and 1 maybe bedridden in room 3 only. There is 2 residents receiving hospice care services during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables. The most current emergency drill was conducted on 12/14/24. The temperature inside the facility was observed to be at 74*F which is within the required range of 68-85*F. The hot water temperature was measured at 118*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA reviewed 1 staff and 1 resident files during this visit. Upon a file review the following items were discussed to be submitted with any changes annually: Licensing fees-Current Criminal Record Clearances LIS536-Current Administrative Organization LIC309-Current Designation of Administrative Responsibility LIC308-Submit Personnel Report LIC500-Submit Affidavit Regarding Client/Resident Cash Resources LIC400-NA Surety Bond LIC402-NA Facility Floor Plan/Plot Plan LIC999-Current Fire Clearance (consistent with terms and limitations of license)-NA Qualifications of Administrator/Facility Manager-Submit Articles of Incorporation/Organization, Constitution and bylaws-NA Partnership Agreement-NA Control of Property-Submit Emergency Disaster Plan LIC610-Submit Plan of Operation (Restricted Health Care Plan)-NA Admission Policies and Procedures-NA Health Screening Report-Facility Personnel LIC503-NA Bacteriological Analysis of Private Water Supply-NA In-service Training Program-NA Medication Procedures-NA Transportation Procedures-NA Job Description/Personnel Policies-NA Exemptions/Waivers and Exceptions-Current First aid/CPR certificates-Current Liability Insurance-Submit Infection Control Plan-Submit Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. Exit interview held. A copy of todays’ report provided.the state’s words, verbatim · CDSS document, Mar 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 3/14/24 at 8:30am. LPA observed the Administrator Certificate expires 8/12/24. LPA met with Manuel Sandoval, Administrator and stated the purpose of todays visit. The facility is licensed for a capacity of 6 non-ambulatory residents of which 2 may receive hospice care services and 1 maybe bedridden in room 3 only. There is 2 residents receiving hospice care services during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 73*F which is within the required range of 68-85*F. The hot water temperature was measured at 105.0*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA reviewed 1 staff and 1 resident files and conducted interviews during this visit. Upon a file review the following items were discussed to be submitted with any changes annually: Licensing fees-Current Criminal Record Clearances LIS536-Current Administrative Organization LIC309-Current Designation of Administrative Responsibility LIC308-Submit Personnel Report LIC500-Submit Affidavit Regarding Client/Resident Cash Resources LIC400-NA Surety Bond LIC402-NA Facility Floor Plan/Plot Plan LIC999-Current Fire Clearance (consistent with terms and limitations of license)-NA Qualifications of Administrator/Facility Manager-Submit Articles of Incorporation/Organization, Constitution and bylaws-NA Partnership Agreement-NA Control of Property-Submit Emergency Disaster Plan LIC610-Submit Plan of Operation (Restricted Health Care Plan)-NA Admission Policies and Procedures-NA Health Screening Report-Facility Personnel LIC503-NA Bacteriological Analysis of Private Water Supply-NA In-service Training Program-NA Medication Procedures-NA Transportation Procedures-NA Job Description/Personnel Policies-NA Exemptions/Waivers and Exceptions-Current First aid/CPR certificates-Current Liability Insurance-Submit Infection Control Plan-Submit Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. Exit interview held. A copy of todays’ report provided.the state’s words, verbatim · CDSS document, Mar 14, 2024