Hampshire Manor

Type of visit: Case Management - Other

Licensing Program Analysts, Graham Gunby and Melissa Parks arrived on April 17, 2026 for an unannounced inspection to follow up on a substantiated complaint investigation. LPA met with Cathy Dustin and explained the purpose of today’s visit. On October 16, 2025, the Department concluded a complaint investigation regarding the following allegation: staff did not prevent resident (R1) from leaving the facility unassisted. The licensee was cited for California Code of Regulations (CCR) Title 22, § 87463(b)(1)(c) Reappraisals. At the time of the complaint visit on October 16, 2025, an immediate civil penalty of $500 was issued, and the licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code § 1569.49. The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. The Welfare and Institutions Code Section 15610.67 defines serious bodily injury 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 facility not providing proper care and supervision, which resulted in R1 eloping and being hospitalized. Today, April 17, 2026, the Department will be issuing a civil penalty per Health and Safety Code § 1569.49 in the amount of $10,000 for a violation that the Department constitutes as serious bodily injury. However, since an immediate civil penalty of $500 was issued on October 16, 2025, the amount of the civil penalty issued today will be $9,500. Exit interview conducted. A copy of the report issued. Appeal rights provided. Cathy Dustin and signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.the state’s words, verbatim · CDSS document, Apr 17, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Graham Gunby arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA met with Administrator, Cathy Dustin`, and explained the purpose of the visit. LPA and Administrator conducted a tour of the interior and exterior of the facility. Areas toured include but not limited to resident bedrooms, bathrooms, kitchen, common areas and backyard. LPA observed required furniture, and lighting throughout the residents' bedrooms and facility. LPA observed residents' bathrooms to be clean, sanitary, and in good repair. LPA observed food supplies of non-perishables for a minimum of seven (7) days and perishable foods for a minimum of two (2) days. Toxins and cleaning supplies are locked and inaccessible to residents in care. The hot water temperature was measured in the kitchen sink at 109.7 degrees Fahrenheit. LPA observed fire detectors and carbon monoxide alarms to be operable. The fire extinguishers are located in the kitchen and garage and were last serviced on 07/02/2025. LPA observed medications to be locked and inaccessible to residents in care. LPA reviewed five (5) resident files. Resident files contained all required documentation. LPA reviewed four (4) staff records. Staff have all required documentation and first aid training. No deficiencies are being cited during today's inspection. Exit interview conducted and a copy of the report will be emailed to Administrator.the state’s words, verbatim · CDSS document, Jan 15, 2026

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.

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

A Non-Compliance conference was conducted on 12/22/2025 at Sacramento North Regional Office via Microsoft Teams. Present in the meeting were facility’s representatives Mary Roberts, Operating Officer, Administrator Cathy Dustin, Acting Regional Manager (RM), Laura Munoz, Licensing Program Manager (LPM), Troy Ordonez and Licensing Program Analyst (LPA), Graham Gunby. Department reviewed the purpose of the NCC, emphasizing the responsibility of the Licensee to ensure the health, safety, and personal rights of residents in care and to maintain substantial compliance with applicable licensing laws and regulations. The Department discussed the facility’s compliance history, including a substantiated complaint in which staff failed to prevent a resident from leaving the facility unassisted, resulting in citations and civil penalties. The Department noted that the appeal of the citation was denied. The Department identified the following areas of concern requiring corrective action submitted by 01/22/2026 · Acceptance and retention of residents with elopement or exit seeking behaviors beyond the facility’s ability to safely supervise. · Failure to consistently update residents Needs and Services Plans and reappraisals to reflect changes in condition. · Insufficient staff training related to elopement risk, exit-seeking behaviors, and supervision requirements. · Administrator oversight, accountability, and fulfillment of required duties. · Improper use, adjustment, or deactivation of door alarms intended to monitor resident movement. *Continued on LIC809-C* The Department discussed the importance of maintaining accurate assessments, conducting timely reappraisals, and ensuring staff are adequately trained to respond to residents’ changing needs. The Licensee/Administrator was advised that failure to implement effective supervision practices and training places residents at risk and may result in increased enforcement action, including enhanced monitoring or administrative action The Department informed the Licensee that a written compliance plan is required and must address the following: · A comprehensive staff training plan specific to the care and supervision of residents who exhibit exit-seeking or elopement behaviors, including identification of who will conduct the training, how training will be monitored, and how completion will be documented. · Administrator completion of reappraisal training through an approved vendor, with documentation of training completion submitted to the Department. · A plan to ensure all door alarms are operational, audible, and routinely monitored. · A plan to ensure staff are informed of residents’ needs and any changes in condition in a timely manner The Licensee was advised that the Department may increase monitoring to verify implementation and ongoing compliance. The NCC was concluded with an explanation that failure to achieve and maintain compliance may result in further enforcement action.the state’s words, verbatim · CDSS document, Dec 22, 2025

Type of visit: POC

Regional Manager (RM) Alycia Rayner, Licensing Program Manager (LPM) Troy Ordonez and Licensing Program Analyst (LPA) Graham Gunby arrived at the facility unannounced on 11/12/2025. RM, LPM and LPA met with Cathy Dustin and explained the purpose of today's visit. During today's visit RM and LPM toured the facility. RM and LPM observed alarm system in the laundry room. RM and LPM observed common areas, resident bedrooms and bathrooms, along with the perimeter of the facility to ensure the health and safety to residents in care. RM, LPM, and LPA reviewed resident files. LPA cleared Plan of Correction from the previous visit on 10/16/2025. No deficiencies cited. Exit interview conducted and a copy of the report will be emailed to Administrator.the state’s words, verbatim · CDSS document, Nov 12, 2025

Allegation investigated: Staff did not prevent resident from leaving the facility unassisted

Licensing Program Analysts Graham Gunby and Bethany Mirlohi arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator, Cathy Dustin. The purpose of the visit was explained, and the complaint investigation findings were discussed. *Continued on LIC9099-C* Substantiated On June 12, 2025, the Department received a complaint alleging that staff did not prevent resident from leaving the facility unassisted resulting in R1 eloping from the facility and requiring hospitalization. The Department reviewed facility records, medical documentation, and staff schedules, and conducted interviews with staff, witnesses, and the Executive Director. The Department also reviewed R1’s physician’s report, care plan, charting notes, and prior incident history regarding wandering and attempted elopement. On June 7, 2025, at approximately 5:20 PM, R1 eloped from the facility without staff’s knowledge. Records confirmed R1 was diagnosed with dementia, required assistance with ADLs, and had a documented history of wandering and exit-seeking behaviors, including prior attempted elopements on 06/30/24, 06/19/24, 06/09/24, 07/12/24, 04/12/25, 04/13/25, and 05/30/25. Caregiver (S1) last observed R1 in the facility at 5:15 PM during shift change. Oncoming caregiver (S2) reported being ill and immediately used the bathroom after arriving on shift, leaving residents unsupervised. While S2 was in the bathroom, R1 exited the facility. Facility charting confirmed R1 was missing from approximately 5:20 PM until approximately 6:20 PM, when R1 was found by a neighbor on their porch. The neighbor called 911. EMS transported R1 to Local Hospital. Medical records confirmed R1 was admitted and treated for urinary tract infection, sepsis, and dehydration, and remained hospitalized until June 10, 2025. Executive Director (S3) acknowledged the facility was aware of R1’s history of wandering but had not updated the care plan to include closer supervision or additional safety measures. Interviews with staff confirmed door alarms were not audible throughout the facility, and no staff were monitoring exits at the time of the incident. Based on observations, interviews conducted, and record reviews, the preponderance of evidence standard has been met. The facility failed to provide adequate care and supervision to ensure R1’s safety, which resulted in R1 eloping unsupervised for approximately one hour and being hospitalized for sepsis and dehydration. Therefore, the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87463, is being cited on the attached LIC 9099-D. A civil penalty in the amount of $500 is assessed. The licensee was informed during today’s visit that a civil penalty is under review and may be assessed at a future date according to Health and Safety Code §1569.49. Exit interview conducted. Appeal rights provided. Report left with facility Administrator.the state’s words, verbatim · CDSS document, Oct 16, 2025 · control 59-AS-20250612102414

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87463(b)(1)(c) · Plan of correction due date: Oct 17, 2025

87463 Reappraisals (b) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident.(1)Significant changes in condition, ..(C)Behavioral expression, as defined in Section 87101, Definitions, that may result in harm to self or others, such as unsafe wandering, elopement, hallucinations, lacking in hazard awareness, or lacking in impulse control. This poses an immediate health and safety risk to residents in care. This requirement is not met as evidenced by: Based on record review, the Licensee failed to ensure that R1 has a current reappraisal/Needs and Service Plan on file, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: Administrator will submit a statement of understanding for section 87463 by 10/17/2025. Administrator will also increase the volume on the alarm system.

Allegation investigated: Residents briefs are not changed often enough/some staff "double-diaper". Staff do not receive adequate training to care for residents. Not enough staff to meet resident needs, Insufficient food supply. Residents may run out of medications. Residents may run out of adult briefs/diapers.

On 7/25/2025 LPA Tryon went to the facility unannounced to complete the complaint. LPA met with staff Kim Bao Tram Tran and spoke with Cathy Dustin by phone. LPA was able to interview one staff member at the visit. Over the course of the complaint, LPA has interviewed the administrator, four staff, toured the facility including common areas, bedrooms, kitchen, bathrooms, storage areas, and garage. Regarding resident briefs, staff related that they change residents on a regular basis, and that they are able to keep them pretty clean and dry overall. LPA only heard of one or two "double-diaper" occasions, which were some time ago. This appears to be going smoothly. Allegation is unfounded. Regarding staff training, all staff interviewed felt that they received plenty of training, and understand their jobs. LPA has reviewed training records. Allegation is unfounded. Regarding there not being enough staff to meet resident needs, staff generally admitted they are very busy, but that overall the residents' needs are met. Allegation is unfounded. Regarding insufficient food supply, LPA has toured the house and reviewed food supplies on at least 2 different occassions over a period of months, interviewed staff. There appears to be a good supply of fresh, frozen and dry goods in the house, and the administrator does a good job of procuring supplies. (cont) Unfounded Allegation is unfounded, Regarding the allegation that facility runs out of medications, LPA interviewed staff and viewed medications and logs. There have only been a few occasions when the home came close to running out of a medication. LPA learned that these occasions happened generally when a hospice service was late delivering medications that the facility had already ordered from them. On one occasion the delivery person had quit, and the home had to follow up. However, overall the home does well at ordering/reordering medications timely. Allegation is unfounded. Regarding the allegation that residents may run out of adult briefs/diapers, LPA has interviewed staff and toured the house. All staff denied running out of briefs. Even if an individual has run short temporarily, the facility has a very large "house supply" of extra briefs and wipes in various sizes and types available, stored in the garage. Therefore, if someone runs out, the supplies are requested from the person responsible for replacing (family members or hospice) there are more than enough extras in the house to cover until a new supply is obtained for the individual. Allegation is unfounded. A finding of UNFOUNDED means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted.the state’s words, verbatim · CDSS document, Jul 25, 2025 · control 59-AS-20250304155656

Allegation investigated: Staff spoke to residents in an inappropriate manner. Staff did not report incidents involving residents as required. Staff did not seek timely medical attention for resident. Staff left residents soiled for extended periods. Licensee does not provide planned activities for residents. Licensee allowed staff to work prior to obtaining a criminal record clearance. Licensee did not ensure staff were appropriately trained to provide care to residents

LPA Tryon visited the facility on 5/28/2025 to deliver the findings for the complaint. LPA met with Administrator Cathy Dustin. Over the course of the investigation LPA has interviewed one witness, administrator, six staff, two residents, reviewed documents, toured the facility. Regarding the allegation that staff spoke to residents in an inappropriate manner, LPA finds that there is no credible evidence that any staff has spoken to residents in an inappropriate manner or in an otherwise disrespectful manner. Allegation is unfounded. Regarding the allegation that staff did not report incidents involving residents as required, LPA has not found evidence that a particular incident was not reported as required. Allegation is unfounded. Regarding the allegation that staff did not seek timely medical attention for a resident, it appears that medical assistance has been sought as appropriate. LPA finds no proof that help was unnecessarily delayed in a particular instance. Allegation is unfounded. Regarding staff leaving residents soiled for extended periods, most staff felt that residents are kept clean Unfounded and dry overall. Most staff related that residents are checked/changed at least every 2 hours, more if needed. Some residents may be “heavy wetters” compared to others, but staff do make an effore to keep them clean. Allegation is unfounded. Regarding the allegation that licensee does not provide planned activities for residents, LPA learned that the facility does have multiple games, activities and so forth that residents can choose. Staff generally related that there are a few residents who enjoy reading, looking at magazines, doing puzzles, exercising/walking. However, it appears that despite activities being offered, residents will generally choose to watch TV, do activities by themselves in their rooms, or visit with each other. The staff cannot force individuals to engage in activities, then can only offer/encourage. LPA finds the allegation to be unfounded. Regarding Licensee allowing staff to work prior to obtaining a criminal record clearance, current staff have clearance; LPA finds no evidence of staff working without clearance. Allegation is unfounded. Regarding Licensee not ensuring staff were appropriately trained to provide care to residents, LPA learned that the amount of training given to a particular staff is related to their past experience and abilities. Some staff only need a little training; others need more. Staff receive training through video training, hands-on training, shadowing experienced staff, and in-person training. Allegation is unfounded. A finding of UNFOUNDED means that the allegation is false, could not have happened, and/or is without a reasonable basis. No deficiencies were cited at this visit. Exit interview conducted.the state’s words, verbatim · CDSS document, May 28, 2025 · control 59-AS-20240829145358

Allegation investigated: Facility staff did not ensure resident was hydrated resulting in hospitalization

LPA visited the facility on 5/28/2025 to deliver the findings of the complaint. LPA met with Administrator Cathy Dustin. Regarding allegation that facility staff did not ensure resident was hydrated resulting in hospitalization, through review of documentation it was learned that R1 had a history of urinary tract infections (UTI), and other medical conditions. There is no indication in the records that staff neglected or failed to keep R1 hydrated, fed, or mismanaged R1’s medications. Chart notes indicate staff were routinely offering R1 hydration. It is documented that on 7/24/2024, R1 refused to drink fluids, take medications, and refused to eat meals. Staff noticed the change in condition and contacted hospice and then sent R1 out to the hospital. R1 was hospitalized and diagnosed with failure to thrive. Therefore, there is no proof that staff were not ensuring resident was hydrated. Allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Unfounded LPA reviewed current and historical Medication Administration Records (MARs), which showed no documented missed doses or medication errors by staff. Additionally, LPA did not observe any medications left unsecured or unattended during the facility visit. Based on the information gathered, there is no evidence to support that staff failed to dispense medications as prescribed. Rather, the findings suggest that any instances of medications being found were the result of resident behavior and not a failure on the part of staff to administer medications appropriately. The allegation is UNSUBSTANTIATED, A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the facility staff did not dispense medications as prescribed therefore the allegation is unsubstantiated. No deficiencies were cited at this visit. Exit interview conducted.the state’s words, verbatim · CDSS document, May 28, 2025 · control 59-AS-20240730111657

Type of visit: Required - 1 Year

On 12/30/2024 LPA Tryon visited the facility unannounced to conduct an annual visit. LPA was greeted by staff, who contacted Administrator Cathy Dustin. Ms. Dustin arrived a short time later. The facility currently has 6 residents. 1 resident is using hospice services. LPA toured the facility including common areas, kitchen, bedrooms, bathrooms, yard, storage, garage. The home is clean, well-furnished and in good repair. Food supplies were reviewed and are adequate to meet the requirement of 2 days perishable and 7 days non-perishable. Food appears to be varied and of good quality. Cleaning supplies and other potentially dangerous items are secured. Medications are centrally stored, logged and locked. Rooms are nicely furnished with appropriate furniture. There are games, books and activities available. Bathrooms are in good condition and clean, plumbing fixtures clean and operable. LPA reviewed 2 resident files and 2 staff files. Appropriate documentation is present. LPA spoke briefly with resident and one staff. LPA reviewed the CARE Tool with Ms. Dustin. At this time, it appears the facility is in substantial compliance with regulations. Exit interview conducted.the state’s words, verbatim · CDSS document, Dec 30, 2024

Allegation investigated: Facility staff are not providing incontinence care to resident

Licensing Program Analyst (LPA) Bethany Mirlohi arrived at the facility unannounced to conduct investigation into allegation listed above. During today’s inspection LPA met with Administrator Cathy Dustin to review the complaint findings. LPA investigated the allegation, “Facility staff are not providing incontinence care to resident”. During investigation LPA interviewed staff and witnesses and reviewed resident documentation. LPA interviewed administrator in which she stated R1 admitted to the facility independent and ambulatory. R1 then had a fall and started on hospice services. R1 began to decline, and caregivers were having a hard time providing incontinence care to R1. Administrator stated incontinence care was always provided, but recommended R1 move to a higher level of care because they only had 1 caregiver per shift. Continuation on 9099-C. Unsubstantiated Two staff reported that they provided incontinence care to R1 however heard other caregivers were unable to provide incontinence care to R1. Two staff reported R1’s room smelled of urine. LPA interviewed 1 caregiver in which they stated they were able to provide incontinence care to resident and did not observe R1 soiled when they began their shift. LPA interviewed staff from hospice agency in which they stated they had no concerns with R1’s care, never observed R1 soiled, and did not observe a smell in resident room. LPA reviewed R1’s documentation, and staff documented they were performing incontinence care on each shift. Due to the information gathered LPA finds allegation to be UNSUBSTANTIATED. Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Aug 22, 2024 · control 59-AS-20240702123620

Type of visit: Required - 1 Year

On 12/6/2023 at 8:45 AM, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA met with Executive Director (ED), Cathy Dustin, and explained the purpose of the visit. LPA observed a total of six (6) residents in care and one (1) staff present at the facility during the annual inspection. At 9:15 AM, LPA and ED toured the interior and exterior of the facility to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, residents' bedrooms, bathrooms, kitchen, garage and backyard. LPA observed required furniture, and lighting throughout the residents' bedrooms and facility. LPA observed residents' bathrooms to be clean, sanitary, and in good repair. LPA observed food supplies of non-perishables for a minimum of one (1) week and perishable foods for a minimum of two (2) days. Toxic and cleaning supplies locked and is inaccessible to residents in care. The hot water temperature was measured in the kitchen at 105 degrees Fahrenheit. First aid kit was completed. LPA observed fire detectors and carbon monoxide alarms to be operable. LPA observed two (2) fire extinguishers located in the kitchen and garage. Fire extinguishers were last serviced on 9/1/2023. Fire drill was last conducted on 10/23/2023. LPA observed medications to be locked and inaccessible to residents in care. LPA observed required Licensing posters posted throughout the facility. At 9:35 AM, LPA reviewed a total of three (3) resident files. Resident files contain signed admission agreements, physician's reports, appraisals, identification sheets, releases, and resident's rights. Medications are centrally stored, locked, and appear to be given per doctor order. LPA compared medications to those being given for three (3) residents and found no discrepancies. LPA reviewed a total of one (1) staff record. Staff has training in first aid and CPR, medication management, restricted health conditions, posture support, hospice care, and other various areas of care provision. LPA request for ED to submit the following to Community Care Licensing for review. Liability Insurance No deficiencies being cited during today's inspection. Exit interview conducted and report providedthe state’s words, verbatim · CDSS document, Dec 6, 2023