Helping Hands Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the Annual Inspection. LPA met with and explained the reason for the visit with Administrator (AD) Phylicia Smith. The Administrator change packet has not been submitted to CCL at this time. This was discussed during the visit today. This facility consists of 6 individual homes which are referred to as Villages. LPA toured each village with AD today and the following was observed in each village: required postings were hung at the entry way, common areas were clean, in good repair and contained required furnishings and lighting. LPA observed required items in bathrooms which were clean with hot water measuring as required. LPA observed hygiene items, paper products, towels, extra bedding, and linens available for use. The kitchens were clean and contained cooking items and appliances functioning as required. Each village had a fire extinguisher which was serviced by Valley Fire 3/23/26. First Aid kits were available for use, containing required items. Door and walkways were unobstructed throughout each village, including entrances and exits. There are shaded seated areas and designated smoking areas available for residents. The facility is surrounded by an iron security gate. The gate itself has 3 pedestrian gates that are unlocked from the “facility side” allowing individuals to exit the property at any time. These gates are locked from the “street side”. See 809C for continuation Annual - Page 2 -Buildings 835 and 825 are currently vacant. Building 881 is the Office. -Building 853 - Green house is licensed for non-ambulatory - 2 male residents live here. The medication Cart is stored in this village. Building 841 - Yellow house is approved for non-ambulatory - 2 male residents live here, R1 and R2. While touring this village, LPA observed a clear container stored in a kitchen cabinet which stored kitchen knives used for cooking which was unlocked. The magnetic lock/latch was in the “unlocked” position. R1 has a diagnosis of Dementia. Building 877 - Orange house is approved for non-ambulatory - 3 female residents live here, R3, R4, R5. During review of resident records, it was discovered that there was not staff training of the hospice care plan for R4 or R1. During the visit, AD called to schedule this training to be completed by Hospice Nurses. Building 865 - Pink house is approved for ambulatory - 1 male resident lives here now, R6. Outside the back of this village is a small shed which LPA observed inside. The shed stored furniture and facility supplies. Inside, LPA observed an unmarked plastic container with a lid containing laundry detergent powder which was stored on top of the dryer in the laundry closet. The detergent was not secured/stored as required. During this visit, LPA conducted resident and staff file reviews. S1 has not started Initial Training - start date 12/2/2025. S2 Training log needs to be updated. Emergency Disaster & Infection Control Plans were also reviewed. It was discovered that Fire and Emergency Drills are not up to date. The last drills were conducted 9/10/2025. See LIC809-C for continuation Annual - Page 3 During this visit, AD and LPA discussed the Change of Ownership application which is in process currently with CAB. AD understands that this facility remains Licensed with CCL as Helping Hands Senior Care until licensed otherwise. The facility Plan of Operation was not available at the facility for LPA to review today. LPA was able to review a current Admission Agreement for Helping Hands Senior Care. Due to time constraints, LPA was not able to complete the inspection today. LPA will return on a later day to complete this Annual Inspection with AD. An exit interview and review of this report was conducted, the report was signed and a copy provided to AD.the state’s words, verbatim · CDSS document, Jul 7, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to conduct a Case Management. LPA met with facility staff, Tammy Pirhekayati, and explained the purpose of today's visit. LPA Hurt informed facility staff if they do plan to sell this facility they will need to contact Centralized Applications Bureau, and follow the required process. LPA Hurt informed the facility staff if they plan to change the facility name they will need to submit the LIC200 form to State Licensing. The facility must ensure all advertising's are using the name they are licensed (Helping Hands.). No deficiencies cited during visit. Exit interview conducted with facility staff Tammy Pirhekayati, and a copy of this report provided.the state’s words, verbatim · CDSS document, May 6, 2026

Type of visit: Case Management - Other

On 11/18/2025, Licensing Program Analyst (LPA) M. Medina arrived to conduct a Case Management visit. LPA arrived, stated purpose of visit and met with Administrator Assistant, Jessica Yglesias. The purpose of the visit was to return R1's resident which was removed for copy on 11/17/2025. No deficiencies cited during Case Management visit. Exit interview conducted with Administrator Assistant and a copy of report will be provided via e-mail.the state’s words, verbatim · CDSS document, Nov 18, 2025

Type of visit: Case Management - Other

On 11/17/2025, Licensing Program Analyst (LPA) M. Medina arrived to conduct a Case Management visit. LPA arrived, stated purpose of visit and met with Administrator Assistant, Jessica Yglesias. The purpose of the visit was to obtain R1's resident file for copy at Fresno Regional Office and obtain a signature from amended reported dated 11/14/2025. No deficiencies cited during Case Management visit. Exit interview conducted with Administrator Assistant and a copy of report will be provided via e-mail.the state’s words, verbatim · CDSS document, Nov 17, 2025

Type of visit: Case Management - Deficiencies

On 11/05/2025, Licensing Program Analysts (LPAs) M. Medina and L. Salazar arrived to conduct Case Management visit. LPA's arrived, stated purpose of visit and met with Administrator Assistant, Jessica Yglesias to conduct visit. Administrator, Elsa Nguyen was contacted by telephone to advise of visit and was unavailable to be present. This case management visit is being conducted to cite deficiencies observed during visits conducted on 10/14/25 and 10/30/25 and during complaint visit on 11/05/25. During previous visits, LPAs toured facility, reviewed records, conducted interviews, and observed residents. LPAs interviews with R7 and S3 state Home Health changed R7’s catheter wrong, facility was unable to provide proof of home health care plan. LPAs observation and interviews with R7 and S3, stating S3 performs the glucose testing for R7 and prepares the dose of insulin. LPA observed S3 conducting glucose testing, insulin dial and R7 injecting themselves with insulin pen. During interview with Administrator and review of facility's program description (plan of operation), there is no proof of scheduled toileting at regular intervals. During record review, LPA observed there was no reappraisal in R2's file. LPAs request of training records for 5 out of 10 restricted health conditions observed involving R2 for oxygen and wound care, R4 for managed incontinence and R7 for catheter and diabetic care. LPAs records review and observation of R2, R2 was hospitalized for 3 days to receive antibiotics for a serious wound on their leg. (Continued from LIC 809) LPAs records review and interviews conducted, there is was no hospice care plan or description of responsibility for R4's care. During interview with residents R3, R4, and administrator there was an incident involving law enforcement on site searching for a suspect, the suspect had entered and was hiding in R6's home. LPAs have conducted 3 facility visits on 10/14/25, 10/30/25 & 11/05/25. Interviews with residents state they may see Administrator once per month, Administrator is not present. During record review and interview with Administrator Assistant, direct care staff have no documented training on file. During record review, LPAs observed R2 has a medical assessment signed by a nurse practitioner, not a physician. During interviews conducted with R2 & R3, they stated that they are not receiving mail. During records review of resident files LPAs observed unopened mail for R5 in their file. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 809D. If not corrected, the violations will have a direct and immediate risk to the health, safety and or personal rights of residents in care. An immediate civil penalty in the amount of $500 is hereby assessed for care and supervision. Issuance of additional civil penalties, if any, are pending and currently under review. Exit interview conducted with Administrator Assistant and Administrator via telephone. Plans of corrections were developed by Elsa Nguyen and reviewed by LPAs. Appeal rights and a copy of this report were provided at the visit.the state’s words, verbatim · CDSS document, Nov 5, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87631(a)(1) · Plan of correction due date: Nov 6, 2025

87631 Healing Wounds (a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who has a healing wound under the following circumstances: (1) When care is performed by or under the supervision of an appropriately skilled professional. This requirement was not met as evidenced by LPAs request for Home Health records and interviews with staff, there is no plan of care.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator to submit written plan to Fresno Regional office to remain in compliance with Title 22 regulation

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Nov 6, 2025

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. **This requirement is not met as evidenced by LPAs review of R2 hospital records stating R2 was sent to the ER via ambulance by the wound specialist clinic due to worsening of the right leg wound. R2 was hospitalized for 3 days to receive antibiotics for a serious infection on their leg. An immediate civil penalty in the amount of $500 is hereby assessed. If not corrected, the violation will have a direct and immediate risk to the health, safety, or personal rights of clients in care.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator to submit written plan to Fresno Regional office to remain in compliance with Title 22 regulation An immediate Civil penalty in the amount of $500 is hereby assessed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87623(b)(2) · Plan of correction due date: Nov 6, 2025

87623 Indwelling Urinary Catheter (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:(2) Ensuring that the bag and tubing are changed by an appropriately skilled professional should the resident require assistance. (A) The bag may be emptied by facility staff who receive instruction from an appropriately skilled professional. **This requirement was not met as evidenced by LPAs interview with R7 and records review of R7s file.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator to submit written plan to Fresno Regional office to remain in compliance with Title 22 regulation

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87628(a) · Plan of correction due date: Nov 6, 2025

87628 Diabetes (a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. **This requirement was not met as evidenced by LPAs observation and interviews with R7 and S3 stating S3 performs the glucose testing for R7 and prepares the dose of insulin. LPA observed S3 conducting glucose testing, insulin dial and R7 injecting themselves with insulin pen.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator to submit written plan to Fresno Regional office to remain in compliance with Title 22 regulation

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87609(b)(4)(A) · Plan of correction due date: Nov 6, 2025

87609 Allowable Health Conditions and the Use of Home Health Agencies (b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident’s medical condition(s). (A) The written agreement shall reflect the services, frequency and duration of care. **This requirement was not met as evidenced by LPAs interviews with R7 and S3, stating Home Health changed R7’s catheter wrong. Facility was unable to provide proof of home health care plan.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator to submit written plan to Fresno Regional office to remain in compliance with Title 22 regulation

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87613(a)(2) · Plan of correction due date: Nov 6, 2025

87613 General Requirements for Restricted Health Conditions (a) Prior to admission of a resident with a restricted health condition, the licensee shall: (2) Ensure that facility staff who will participate in meeting the resident’s specialized care needs complete training provided by a licensed professional sufficient to meet those needs. **This requirement was not met as evidenced by LPAs request of training records for 5 out of 10 restricted health conditions observed involving R2 for oxygen and wound care, R4 for managed incontinence and R7 for catheter and diabetic care.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator to submit written plan to Fresno Regional office to remain in compliance with Title 22 regulation

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87463(e) · Plan of correction due date: Nov 6, 2025

87463 Reappraisals (e) The licensee shall immediately, or as soon as reasonably possible, bring any significant change in condition, as defined in Section 87101, Definitions, to the attention of the appropriate licensed medical professional and if applicable, other specialized care provider. Documentation of such communication shall be added to the resident's record and shall include: **This requirement was not met as evidenced by LPA review of R2's records. There was no reappraisal observed in R2s file.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator to submit written plan to Fresno Regional office to remain in compliance with Title 22 regulation

From the deficiency page — Deficiency type: Type A · Section cited: CCR87633(b)(4) · Plan of correction due date: Nov 6, 2025

87633 Hospice Care of Terminally Ill Residents (b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following:(4) A description of the area of licensee’s responsibility for implementing the plan including, but not limited to, facility staff duties; record keeping; and communication with the hospice agency, resident’s physician, and the resident’s responsible person(s), if any. This description shall include the type and frequency of the tasks to be performed by the facility. **This requirement was not met as evidenced by LPAs records review and interviews conducted, there is was no hospice care plan or descrption of resposibilty for R4's care.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator to submit written plan to Fresno Regional office to remain in compliance with Title 22 regulation

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.2(c) · Plan of correction due date: Nov 6, 2025

(c) “Care and supervision” means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. **This was not met as evidenced by interview with residents and administrator there was an incident involving law enforcement on site searching for a suspect, the suspect had entered and was hiding in R6's home.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator to submit written plan to Fresno Regional office to remain in compliance with Title 22 regulation

From the deficiency page — Deficiency type: Type A · Section cited: CCR87405(a) · Plan of correction due date: Nov 19, 2025

Administrator Qualifications: a)All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation.**This was not met as evidenced by Adminstrator has not been available in person with LPAs for 3 visits on 10/14/25, 10/30/25 & 11/0525. Interviews with residents state they may see Administrator once per month, Administrator is not present.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator to submit written plan to Fresno Regional office to remain in compliance with Title 22 regulation

From the deficiency page — Deficiency type: Type B · Section cited: CCR 8411(c) · Plan of correction due date: Nov 21, 2025

Personnel Requirements - General: All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 **This was not met as evidenced by, based on record review and interview with Administrator Assistant, direct care staff have no documented training on file.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator to submit training records for all staff to Fresno Regional office by plan of correction due date

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(d) · Plan of correction due date: Nov 21, 2025

Personnel Requirements - General: All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: **This was not met as evidenced by, based on record rerview and interview with Administrator Assistant, direct care staff have no documented training on file.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator to submit training records for all staff to Fresno Regional office by plan of correction due date

From the deficiency page — Deficiency type: Type B · Section cited: CCR87209(a)(2) · Plan of correction due date: Nov 21, 2025

Program Flexibility: a)The use of alternate concepts, programs, services, procedures, techniques, equipment, space, personnel qualifications or staffing ratios, or the conduct of experimental or demonstration projects shall not be prohibited by these regulations provided that: (2) A written request for a waiver or exception and substantiating evidence supporting the request shall be submitted in advance to the licensing agency by the applicant or licensee. **This was not met as evidenced by, R2 has a medical assessment signed by a nurse practioner, not a physician,the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator to submit written plan to Fresno Regional office to remain in compliance with Title 22 regulation

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(15) · Plan of correction due date: Nov 19, 2025

Personal Rights of Residents in All Facilities: (a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: (15) To send and receive unopened correspondence in a prompt manner. **This was not met as evidenced by, interviews conducted with R2 & R3 who stated that they are not receiving mail. During records review of resident files LPAs observed unopened mail for R5 in their file.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator to submit written plan to Fresno Regional office to remain in compliance with Title 22 regulation

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(9) · Plan of correction due date: Nov 21, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (9) To present grievances and recommend changes in policies, procedures, and services to the facility staff, management, and governing authority, and to any other person without restraint, coercion, discrimination, reprisal, or other retaliatory actions..**Thiis requirement was not as evidenced by LPAs interviews, licensee stated R4 brought problems to the facility and needs to find another place to live.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator will provide training to staff and submit agenda and sign in sheets to Fresno Regional Office by plan of correction due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87221 · Plan of correction due date: Nov 21, 2025

87221 Resident Councils The facility shall permit the formation of a resident council by interested residents, provide space and post notice for meetings, and provide assistance in attending meetings for those residents who request it. In order to permit a free exchange of ideas, at least part of each meeting shall be allowed to be conducted without the presence of any facility personnel. Residents shall be encouraged, but shall not be compelled to attend. The purpose of such an organization shall be to work with the administration in improving the quality of life for all residents by enriching the activity program and to discuss the services offered by the facility and make recommendations regarding identified problems. This requirement was not met as evidenced by LPAs interviews with residents and records review. There has been no notice or resident council formed.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator to submit written plan to Fresno Regional office to remain in compliance with Title 22 regulation

Type of visit: Case Management - Annual Continuation

On 10/30/2025 Licensing Program Analysts (LPAs) M. Medina and L. Salazar conducted an unannounced Case Management Annual Continuation visit. LPAs arrived, introduced self, and stated purpose of visit. LPAs met with Administrator Assistant, Jessica Yglesias to conduct visit. . Annual continuation visit is being conducted to complete items from previous visit on 10/14/2025. Case management visit was a continuation for staff file review and resident records review, and a continuation of the care tool. Licensee to submit the following updated documents to Fresno Regional office no later than 11/14/2025: Copy of Administrator certificate, copy of liability insurance, LIC 308 (Designation of Administrative Responsibility), LIC 500 (Personnel Report), and LIC 9020 (Register of Facility Clients/Residents). Deficiencies are being cited on the attached 809-D. Due to time constraints, additional deficiencies will be cited and discussed at a meeting to be scheduled with the Licensee and Administrator in the Fresno Regional office. Exit interview conducted by telephone with Administrator and signed by Administrator Assistant and a copy provided for facility records.the state’s words, verbatim · CDSS document, Oct 30, 2025

Type of visit: Required - 1 Year

On 10/14/2025, Licensing Program Analysts (LPAs) M. Medina and L. Salazar conducted an unannounced Annual Required inspection. LPAs arrived and allowed entrance by Jessica Yglesias, Administrative Assistant to conduct visit. Administrator, Elsa Nguyen was not available to conduct today's inspection. The facility has 7 separate housing units on site that serve individuals as follows: Building 1 address 877 S Willow, 3 bedroom, 6 non-ambulatory Building 2 address 853 S Willow, 2 bedroom, 4 ambulatory Building 3 address 825 S Willow, 2 bedroom, 4 ambulatory Building 4 address 865 S Willow, 2 bedroom, 4 ambulatory Building 5 address 841 S Willow, 3 bedroom, 6 non-ambulatory Building 6 address 835 S Willow, 3 bedroom, 6 non-ambulatory Building 7 address 881 S Willow, staff office LPA's conducted facility tour of all buildings except building 3, which was locked and inaccessible. All buildings (homes) observed to be clean, odor free, and a comfortable temperature. Individual bedrooms are have required furnishings, additional linens are available in each hallway closet area. Each individual home has a washer/dryer available. Each home has a fully furnished living room and dining room that has adequate seating available for residents in each home. Each home also has a full kitchen with pots, pans, cups, plates, utensils. LPAs observed a 2-day supply of perishable foods and a 7-day supply of non-perishable food stored in the office. Each home has a refrigerator that contains small snacks, and drinks available. Meals are prepared in one kitchen and provided to individual homes. Resident bathrooms toured, fixtures observed to be operational. Bathrooms observed to have grab bars in the shower/tub areas with skid resistant applications. Water temperature ranged from 110 degrees F - 115 degrees F. (Continued from 809) During facility tour it was observed that R1 is bedridden and facility does not have bedridden clearance. First aid kit contains all the required items. A fire extinguisher is mounted on the wall of each home with a service date of 3/27/2025. All homes have smoke detectors, carbon monoxide and sprinkler systems. Medications observed to be locked and secured in a medication cart that is stored in building 4. Medications reviewed. Staff files reviewed, LPAs observed S1 is not fingerprinted and cleared and S2 has a exemption that has not been transferred to facility. Both S1 and S2 have worked 5 days or more between 9/29/2025 and 10/12/2025. Perimeter of the grounds is surrounded by a gate which is locked from the exterior. Exit gates observed to be self latching upon exit. There are benches around the property under covered patios for resident seating. Due to time constraint, resident and staff files will be reviewed at a later date. Based on today's visit, and per CCR Title 22, deficiencies are being cited on the attached 809-D. Immediate civil penalties are being assessed in the amount of $500 for Caregiver Background clearance, $500 for Caregiver exemption transfer request, and $500 for Bedridden fire clearance totalling $1500. If not corrected, the violations will have a direct and immediate risk to the health, safety, or personal rights of clients in care. An exit interview was conducted with Administrative Assistant. A copy of this report and appeals rights were discussed and provided at the time of visit. A plan of correction was developed by Administrator Assistant and reviewed with LPAs.the state’s words, verbatim · CDSS document, Oct 14, 2025

Allegation investigated: Staff are mishandling the residents medications

On June 18, 2025, Licensing Program Analyst (LPA) Rachel Bruce conducted an unannounced inspection visit to the above facility for the purpose of investicating, interviewing and delivering findigs on the above allegation. The allegation of mishandling medication was in relation to proper storage. Inspection and investigation revealed that although the medications were locked away, however the lock still allowed access. Investigation revealed the preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. Per California Code of Regulations, Title 22, a deficiency is being cited on the attached 9099-D. An exit interview was conducted and a copy of this report along with appeal rights and plans of correction were provided. Substantiatedthe state’s words, verbatim · CDSS document, Jun 18, 2025 · control 24-AS-20250612091942

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80075(k)(1) · Plan of correction due date: Jun 25, 2025

80075(k)(1) - Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by Medication is currently stored in locked cabinet in each kitchen area however the lock is not serving its intended purpose and medication is accessible.the state’s words, verbatim · CDSS document, Jun 18, 2025

Plan of correction: Facility will store medication centrally in the office until appropriate locks can be purchased and installed. Proof by picture will be send to CCL by the due date of June 25, 2025.

Type of visit: Prelicensing

LPA Lissett Padgett arrived to conduct a follow-up Prelicensing visit. LPA was granted entry by Ray Gilbert. LPA enter building 835 and tested the water temperature. Water temperature was found to be 118.0 in bathroom 1 and 115.7 in bathroom 2. Pre-Licensing deficiencies have been resolved. Pre-Licensing is now complete. Component III conducted during this visit. Exit interview conducted. Copy of this report was emailed to applicants.the state’s words, verbatim · CDSS document, Jul 17, 2024

Type of visit: Prelicensing

Licensing Program Analyst Lissett Padgett arrived conducted an announced Pre-Licensing continuation inspection. LPA met with applicant Ray Gilbert (RG). Facility was toured with RG. LPA observed the following issues noted on the 6/18/2024 inspection have been corrected: 1. Trash can with lid in all bathrooms and in kitchens- observed to be in compliance in each bulding 2. Designated centrally stored medication cabinet installed in each resident building- observed to be in compliance 3. Install a lock on shed located at building 4 which stores paint supplies and chemicals - LPA observed combination lock installed 3. Signal system to be installed in each resident building- all residents will have signal necklace - when pressed number is shown 4. Install lock on cabinet that will store chemicals and knives/sharps- LPA observed lock installed under each kitchen sink cabinet. 5. Lower water temperature within the 105-120 degree F range- LPA rechecked bathroom sink water temperatures in each building, the following are the results: Building 825:113.5 degrees F, 112.5 degrees F Building 841: 114.4 degrees F, 114.1 degrees F Building 853: 114.4 degrees F, 114.1 degrees F Building 865: 114.8 degrees F, 114.3 degrees F Building 877: 115.3 degrees F, 117.3 degrees F continued on LIC809-C 6. Clean shower and floors in building 5- LPA observed this has been cleaned. 7. Install grab bar near toilet in building 5- observed grab bar has been installed 8. Install screen in bedroom window in building 5- observed screen has been installed. 9. Emergency lighting (e.g. flashlights) to be placed in each building- observed to be in compliance 10. Required postings in each building- observed to be in compliance 11. remove fencing materials from the perimeter of grounds- observed to be in compliance 12. Thermometers for refrigerator and freezer- observed to be in compliance LPA observed the water temperature in Building 835 to be at 80 degrees F and 86 degrees F and will need to be brought into compliance prior to licensure. RG will contact this LPA when ready for reinspection.the state’s words, verbatim · CDSS document, Jun 28, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Lissett Padgett arrived announced to conduct a Pre-Licensing inspection. LPA met with applicants Elsa Nguyen and Ray Gilbert. This facility has 7 buildings on the premises and are as follows: Building 1 address 877 S Willow, 3 bedroom, capacity for 6 Building 2 address 853 S Willow, 2 bedroom, capacity for 4 Building 3 address 825 S Willow, 2 bedroom, capacity for 4 Building 4 address 865 S Willow, 2 bedroom, capacity for 4 Building 5 address 841 S Willow, 3 bedroom, capacity for 6 Building 6 address 835 S Willow, 3 bedroom, capacity for 6 Building 7 address 881 S Willow, staff office LPA began the tour by entering building 3. This building has been fully furnished. Ambient temperature was 74 degrees F. Common areas have adequate furnishings and lighting. All 3 resident bedrooms have the required furnishings, bed linens, proper lighting and smoke detectors. Smoke/Carbon Monoxide detectors were tested and observed and in working order. Windows and screens are in good condition. LPA observed a supply of extra bed linens, towels, and personal hygiene and grooming products. Hot water temperature in bathroom measured at 125.2 degrees F. LPA observed Non-Skid flooring in the showers, grab bars in shower and near toilet, soap, paper towels present along with storage available for client personal items. Kitchen observed to have supply of dishes, plates, utensils, pots and pans. Food storage and preparation areas are clear and appropriate for food preparation. Knives and cleaning supplies and chemicals are stored in locked cabinet under the sink. Appliances observed to be in working order. LPA observed a 7 day of non-perishable food stored in a pantry and 2 day supply of perishable food in the refrigerator. Washer and Dryer observed in the laundry closet with additional storage space available above. Doors and passageways are unobstructed throughout the home. First aid kit contains all the required items. A fire extinguisher is mounted on the wall, it did not have an inspection date but the correct pressure gauge as indicated on the meter. Buildings 1-5 and Building 6 are will be furnished upon admission of residents. Medications will be stored in locked medication cabinet in each building. Outside of the facility toured. There is a seating area and a self-latching gate found to be working properly. LPA observed temporary fencing along the perimeter of the property. There is no swimming pool on the premises. The following observed will need to be brought into compliance: 1. Trash can with lid in all bathrooms and in kitchens 2. Designated centrally stored medication cabinet installed in each resident building. 3. Install a lock on shed located at building 4 which stores paint supplies and chemicals. 3. Signal system to be installed in each resident building. 4. Install lock on cabinet that will store chemicals and knives/sharps 5. Lower water temperature within the 105-120 degree F range 6. Clean shower and floors in building 5 7. Install grab bar near toilet in building 5 8. Install screen in bedroom window in building 5 9. Emergency lighting (e.g. flashlights) to be placed in each building 10. Required postings in each building 11. remove fencing materials from the perimeter of grounds 12. Thermometers for refrigerator and freezer A copy of this report was given to Applicants, whose signature confirms receipt of this report.the state’s words, verbatim · CDSS document, Jun 18, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: Initial Capacity: 30 Census (if any clients in care): 0 COMP II Participants: Elsa Nguyen (applicant/licensee, administrator) Interview Method: Microsoft Teams On 4/26/24, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 26, 2024