Heritage Gardens

Allegation investigated: Resident sustained fractures and other injuries due to staff neglect or physical abuse Licensee does not ensure there are adequate staff to meet resident's needs Staff did not address a resident's change in medical condition in a timely manner Staff did not ensure residents toileting needs were met

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Administrator Jessica Ramos, and discussed the purpose of the visit. Regarding allegations above, The Administrator informed LPA that resident #1 (R1) never resided in the assisted living facility but resided in the skilled nursing facility. LPA obtained a resident roster from the skilled nursing facility that verifies R1 lived at the skilled nursing facility. Based on LPA's interviews and record review, the above allegations are Unfounded. An Unfounded finding means, the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted where this report was discussed and a copy of this report was provided to Administrator Jessica Ramos at the conclusion of the visit. Unfoundedthe state’s words, verbatim · CDSS document, Jul 1, 2026 · control 56-AS-20260623172640

Allegation investigated: Resident sustained an unexplained head injury resulting in death. Staff did not inform resident's responsible party of incident in a timely manner. Staff did not seek timely medical care for resident.

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to deliver findings on the allegations mentioned. LPA met with Administrator Jessica Ramos and explained the purpose of the visit. The Department's investigation involved interviews and records review. Allegation #1- Resident sustained an unexplained head injury resulting in death. Resident #1 (R1) resided at Heritage Gardens Facility. During R1’s residency, R1 sustained an unwitnessed fall. Based on information obtained during the investigation, the fall is believed to have occurred while R1 was attempting to use their wheelchair for mobility assistance. As a result of the incident, R1 sustained bruising to their head and multiple lacerations to their arms. Emergency medical services were contacted, and R1 was transported to Loma Linda University Medical Center for evaluation and treatment. R1 remained hospitalized for four (4) days. During the hospital stay, medical records were reviewed. Unsubstantiated Findings indicated that R1 experienced respiratory complications. A CT scan revealed no abnormalities to the carotid arteries; however, documentation noted a blockage of the internal carotid artery. This condition is associated with an increased risk of neurological impairment, including stroke. Medical review further indicated that R1 had pre-existing conditions. There was no documentation indicating trauma or suspicious activity related to the fall. The attending physician did not attribute R1’s death to the fall. During the investigation, records review and staff interviews were conducted. Documentation reviewed indicated the facility followed the resident’s care plan. The facility implemented measures to address fall risk, including coordination with R1’s private insurance to request additional interventions, such as a bed alarm. At the time of the incident, alarms were in place and operational. Staff conducted routine checks, assisted with medication management, and addressed R1’s mobility needs, including the use of a wheelchair for transfers. On the day of the incident, documentation revealed that R1 received their prescribed medications, and routine checks were completed by staff. Based on the information obtained, there is insufficient evidence to support the allegation that the facility failed to provide adequate care and supervision. The allegation of neglect/lack of care and supervision is Unsubstantiated. Allegation #2 - Staff did not inform resident's responsible party of incident in a timely manner. Department staff conducted the investigation and revealed that at the time of the incident, the facility’s Medication Technician (Med-Tech) was notified by R1’s roommate that R1 had fallen. The Med-Tech responded immediately to the room and observed R1 on the floor. The MedTech initiated emergency response procedures. Vital signs were checked, and R1’s level of consciousness was evaluated. Emergency medical services were contacted without delay. Based on the information obtained, there is insufficient evidence to support the allegation that the facility failed to inform responsible parties in a timely manner. The allegation is Unsubstantiated. Regarding allegation #3 - Staff did not seek timely medical care for resident. Records reviewed during the investigation documented a dispatch time of 2101 hours. This documentation is consistent with staff statements and supports that emergency medical services were contacted promptly following the incident. The facility staff made timely notifications to the resident’s responsible party, and to the resident’s private insurance provider to address any additional preventive measures related to the incident. Based on the information obtained, the facility responded promptly and appropriately to the incident, including immediate assessment, timely contacting of emergency medical services, and required notifications. The allegation of neglect/lack of care and supervision is Unsubstantiated.the state’s words, verbatim · CDSS document, Apr 17, 2026 · control 56-AS-20240927152021

Allegation investigated: Staff neglect resulted in a resident sustaining multiple burns. Staff did not timely address a resident's change in medical condition.

On 04/6/2026,Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility to deliver findings on a complaint alleging, Staff neglect resulted in a resident sustaining multiple burns and Staff did not timely address a resident's change in medical condition. LPA Singh met with front staff and was granted entry into the facility. LPA Singh was greeted by facility administrator Jessica Ramos and stated the purpose of this visit. The investigation conducted by LPA Singh consisted of observations,interviews and records review. First Alegation:- Staff neglect resulted in a resident sustaining multiple burns. LPA Singh met with the resident to discuss the accidental fire that led to their burn injuries and subsequent admission. The resident admitted that the incident occurred while they were receiving 2 liters of supplemental oxygen at the facility, explaining that they inadvertently attempted to light a cigarette after forgetting they were connected to the supply. R#1 self manage their oxygen and has quit smoking since the incident due to health reasons. This account was corroborated by the reporting party, who noted that the resident had previously been instructed not to smoke in the room while using oxygen. Unsubstantiated Despite the accident, the resident expressed satisfaction with the facility, describing the staff as attentive and stating there were no concerns regarding the quality of care or supervision provided. Second Allegation:- Staff did not timely address a resident's change in medical condition. LPA Singh conducted interviews with staff and residents concerning an un-witnessed fall involving Resident #1 (R1), which occurred while the resident was maneuvering a power chair outside the community while at the bank. Following the incident, the resident confirmed they were evaluated by facility personnel upon their return to the building. The resident further reported that staff provided the necessary medical attention to address the situation, ensuring their health and safety were prioritized after the fall. Statements from the resident, staff, and the reporting party consistently indicated that the facility provides adequate care and supervision, with no evidence of neglect or lack of oversight. Furthermore, Five (5)out of Five(5)residents and Three(3) out three(3) staff corroborated that the facility maintains a high standard of care, noting that personnel are attentive, assist in a timely manner, and respond appropriately to any changes in a resident's medical condition. Statements, records, and interviews obtained did not provide sufficient information to corroborate the allegation. Based on the evidence found during the investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC9099, LIC9099 C were discussed and provided to Facility Administrator Jessica Ramos.the state’s words, verbatim · CDSS document, Apr 6, 2026 · control 56-AS-20251106142042

Allegation investigated: Staff did not provide a safe environment for a resident in care.

Licensing Program Analysts (LPAs) Sarina Ramirez and Eldin Serrano conducted an unannounced visit to the facility to initiate a complaint investigation. LPAs met with Administrator Jessica Ramos, and explained the purpose of the visit. It is alleged staff are not providing a safe environment for a resident in care. Based on interviews with staff and residents, it was determined that Resident 1 (R1) was pushed by Resident 2 and 3 (R2 & R3) on accident. R1, R2, and R3 all are in wheelchairs, R2 can only maneuver in reverse, R2 did not realize R1 was in the same path. R3 is non verbal, Based on interviews it is noted R1 is mostly upset because R2 and R3 did not apologize. Based on LPA's observations and interviews, the above allegation is unsubstantiated. This means that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted where this report was discussed, and a copy was provided to Administrator Jessica Ramos at the conclusion of the visit. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 23, 2026 · control 56-AS-20260121131011

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Sarina Ramirez and Eldin Serrano made an unannounced visit to the facility to conduct a required annual inspection. LPAs met Administrator Jessica Ramos, and discussed the purpose of the visit. The facility is a Residential Care Facility for Elderly (RCFE) with a license capacity of (64), and a current census of (55). LPAs conducted a general inspection of facility, which included, but was not limited to, the following: Physical Plant: Indoor and outdoor passageways were kept free of obstruction. The facility has no swimming pool or similar bodies of water. The facility has sufficient space for resident activities. Seven (7) resident bedrooms and Seven (7) resident’s bathrooms were inspected, hot water temperature measured at 95 to 106.1 degrees F, technical violation issued. The facility is equipped with operating smoke/carbon monoxide alarms, laundry equipment, and telephone service. The facility has posted in a common area, personal rights, facility sketch, the Community Care Licensing complaint poster, Ombudsman poster, menu, activities, and license. Cleaning supplies and sharps were kept inaccessible to residents in care. Last fire drill was conducted 12/18/25. Food Service: Kitchen and dining areas were maintained cleaned. Non-perishable and perishable food supply is sufficient for number of residents in care. Facility refrigerators and freezers were maintained in operating condition. Health Related services: LPA audited one (1) resident medication at random and found discrepancies, deficiency issued. Resident’s medications are labeled and centrally stored in a locked cart. Continuation on LIC809-C Record Review: Five (5) resident files reviewed were observed to be complete. Five (5) staff files reviewed were observed to be complete. Based on LPAs observations and records reviewed, deficiencies and a technical violation are being cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report (LIC809), (LIC809-C), LIC 809D, LIC 9102 were discussed to Administrator Jessica Ramos, copies of the reports were provided with appeal rights to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jan 23, 2026

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff threatened resident with eviction.

Licensing Program Analysts (LPAs) Sarina Ramirez and Eldin Serrano conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPAs met with Administrator Jessica Ramos, and discussed the purpose of the visit. Regarding Allegation Staff threatened resident with eviction. It is alleged Resident one (R1) had the option of moving into a single room from their double room or they would get evicted. LPAs interviewed four (4) staff, all 4 informed LPA R1 nor other residents have been threatened to be evicted. LPAs interviewed seven (7) residents, 6 out of 7 stated they have not been threatened with eviction without any notice. 1 out of the 7 residents stated they were threatened to be evicted; they were given the option of moving into a small room or to move out. Based on LPAs observations, record review, and interviews, the above allegations are Unsubstantiated. A finding that complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted, and this report was discussed, and a copy was provided to Administrator Jessica Ramos at the conclusion of the visit. Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 16, 2025 · control 56-AS-20250911150242

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Sarina Ramirez and Eldin Serrano made an unannounced visit to the facility to conduct a required annual inspection. LPAs met Director of Operations Samuel Goings, and discussed the purpose of the visit. The facility is a Residential Care Facility for Elderly (RCFE) with a license capacity of (62), and a current census of (51). LPAs conducted a general inspection of facility, which included, but was not limited to, the following: Physical Plant: Indoor and outdoor passageways were kept free of obstruction. The facility has no swimming pool or similar bodies of water. The facility has sufficient space for resident activities. Four (4) resident bedrooms and Four (4) resident’s bathrooms were inspected, hot water temperature measured at 105.9 degrees F. The facility is equipped with operating smoke/carbon monoxide alarms, laundry equipment, and telephone service. The facility has posted in a common area, personal rights, facility sketch, the Community Care Licensing complaint poster, Ombudsman poster, menu, activities, and license. Cleaning supplies and sharps were kept inaccessible to residents in care. Last fire drill was conducted 02/12/25. Food Service: Kitchen and dining areas were maintained cleaned. Non-perishable and perishable food supply is sufficient for number of residents in care. Facility refrigerators and freezers were maintained in operating condition. The facility has posted a weekly menu. Health Related services: LPAs reviewed four (4) resident medications. Resident’s medications are labeled and centrally stored in a locked room; however staff are not administering medications at prescribed times or signing after administering; deficiency will be issued. Continuation on LIC809-C Record Review: Seven (7) resident files reviewed were observed to be complete. Seven (7) staff files reviewed were observed to be incomplete, S1 had a missing health screening report signed by a physician, technical violation will be issued. Based on LPAs observations and records reviewed, deficiencies are being cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report (LIC809) and LIC 809D was discussed to Director of Operations Samuel Goings. Copies of the reports were provided with appeal rights to the Director of Operations at the conclusion of the visit.the state’s words, verbatim · CDSS document, Feb 25, 2025

Allegation investigated: Staff unlawfully evicted a resident

Licensing Program Analyst (LPA) Bernadette Allen met with Jessica Ramos Administrator at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office on 2/5/2025 at 1:45 PM to deliver the findings for the above allegation. LPA Allen explained the purpose of the requested office visit. The investigation consisted of interviews with outside parties and file review. During the interviews with outside parties and the administrator, Jessica Ramos, as well as a review of the files, it was confirmed that Resident 1 (R1) received an eviction notice on July 5, 2024. Both Jessica and R1's responsible party have indicated that they have been collaborating to find a new facility that meets R1's needs, but their efforts have been unsuccessful so far. They have both confirmed that R1 has been and will continue to reside at the current facility until suitable housing that meets R1's needs and services is found. Unfounded Based on interviews and evidence gathered during the investigation, the above allegation is found to be Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and where this report was discussed with Jessica Ramos Administrator and a copy of the report was provided at the conclusion of the visit with appeal rights.the state’s words, verbatim · CDSS document, Feb 5, 2025 · control 56-AS-20240708112046

Allegation investigated: Facility staff did not seek timely medical attention for resident in care

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPA met with Administrator Jessica Ramos, and discussed the purpose of the visit. Regarding the allegation above, LPA’s record review and interviews reveals, R1 lives on the skilled nursing side of the facility. Based on LPA record review and interviews the above allegation is Unfounded. An Unfounded finding means, the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted where this report was discussed, and a copy of this report was provided to Administrator Jessica Ramos at the conclusion of the visit. Unfoundedthe state’s words, verbatim · CDSS document, Jan 16, 2025 · control 56-AS-20250114091007

Allegation investigated: Staff did not respond to resident's call button in a timely manner. Staff did not follow resident's diet plan. Staff did not allow resident use restroom. Staff does not ensure facility is free of pests. Staff did not ensure resident's bathroom is clean and sanitized.

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Administrator Jessica Ramos, and discussed the purpose of the visit. Regarding allegations above, The Administrator informed LPA that resident #1 (R1) never resided in the assisted living facility but resided in the skilled nursing facility. LPA obtained a resident roster from the skilled nursing facility that verifies R1 lived at the skilled nursing facility. Based on LPA's interviews and record review, the above allegation is Unfounded. An Unfounded finding means, the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted where this report was discussed and a copy of this report was provided to Administrator Jessica Ramos at the conclusion of the visit. Unfoundedthe state’s words, verbatim · CDSS document, Dec 26, 2024 · control 56-AS-20241220125755

Allegation investigated: Staff does not ensure facility serves food of good quality to residents in care

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPA met with Administrator Jessica Ramos and discussed the purpose of the visit. Regarding the allegation above, It is alleged that the facility does not stick to the provided daily menu that is displayed for residents. Investigation consisted of review of the food supply, food receipts, and menu. Based on review and interviews with facility staff and residents in the facility the allegation is unsubstantiated. LPA conducted three (3) staff interviews, 3 out of the 3 staff informed LPA the menu almost never gets changed unexpectedly and if it does staff notify residents same day. Interviews with 5 residents in the facility could not corroborate the allegation. Unsubstantiated An Unsubstantiated complaint means, that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted with Administrator Jessica Ramos and a copy was provided to Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Dec 6, 2024 · control 56-AS-20241204143348

Allegation investigated: Staff do not ensure resident's needs are met.

Licensing Program Analysts (LPAs) Sarina Ramirez ad Mary Rico conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPAs met with Administrator Jessica Ramos and explained the purpose of the visit. Regarding the allegation above, LPA Ramirez and LPA Rico conducted 5 staff interviews. 5 out of the 5 staff informed LPA residents needs are being met. 3 out of the 5 staff stated to LPAs they encourage residents to be independent, but never refuse assistance. LPA conducted 7 resident interviews. 2 out of the 7 residents stated staff are not ensuring residents needs are being met; 3 out of the 7 residents stated staff ensure their needs are being met, during the investigation 2 out of the 7 residents were unable to answer LPAs questions to corroborate the above allegation. Unsubstantiated Based on record review R1 care plan indicates R1 is independent and is encouraged for self- care tasks. Based on LPAs observations, record review, and interviews, the above allegations are Unsubstantiated. A finding that complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and this report was discussed and provided to Administrator Jessica Ramos along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Oct 22, 2024 · control 56-AS-20241018122741

Allegation investigated: Staff did not ensure dinner was available to resident in care

Licensing Program Analysts (LPAs) Magda Malcore and Becky Mann conducted an unannounced visit to the facility to conclude the investigation on the above allegation. LPAs met with Sam Goings, Director of Operations, and explained the purpose of the visit. The investigation consisted of record review, interviews with staff and residents. Regarding the allegation staff did not ensure dinner was available to resident in care, interviews with outside parties, five (5) staff and six (6) residents reveals, for every meal service, a meal ticket is created and placed along side a meal tray for each resident. Staff deliver the meal trays to the residents in their rooms or in the dining area. All residents interviewed stated that staff have not missed provided them with meal service. Based on evidence obtained during the investigation, the above allegation is Unfounded. Unfounded means the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted where this report was discussed and a copy provided to the Director of Operations at the conclusion of the visit. Unfounded Regarding the allegation, unauthorized individual residing in resident's room, there is not enough evidence to corroborate the allegation. Five (5) staff interviewed deny that unauthorized individual are sleeping and residing in residents’ rooms. Five (5) out of six (6) residents interviewed deny that unauthorized individuals are sleeping and residing in their rooms. Based on evidence obtained during the investigation, the above allegations are Unsubstantiated. Although, the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted where this report was discussed and a copy of this report was provided with appeal rights to the Director of Operations at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 15, 2024 · control 56-AS-20240627142625

Allegation investigated: Facility staff did not meet resident's incontinence care needs

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to conclude the complaint investigation and deliver findings on the above allegation. LPA met with Administrator Jessica Ramos who was informed of today’s visit. Regarding the allegation, staff did not meet the resident's incontinence care needs, interviews with five (5) staff and six (6) residents reveals not enough evidence to corroborate the allegation. Based on LPA record review, staff and resident interviews, the allegation above is Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed and a copy of this report was provided to Administrator Ramos at the conclusion of the visit. Unsubstantiated An exit interview was conducted where reports (LIC9099/LIC9099C/LI9099-D) were discussed with Administrator Ramos. A copy of the reports were provided with appeal rights to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 20, 2024 · control 56-AS-20240315115831

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87217(b) · Plan of correction due date: Sep 21, 2024

87217 Safeguards for Resident Cash, Personal Property, and Valuables(b)Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. This requirement is not met at evidenced by: The licensee did not comply with the section cited above by not safeguarding R1's personal property as R1's dresser/mirror and night stand were documented at missing.the state’s words, verbatim · CDSS document, Sep 20, 2024

Plan of correction: The facility reimbursed resident for missing furniture on 3/14/24. No futher action is required.

Allegation investigated: Illegal eviction

Licensing Program Analyst (LPA) Magda Malcore conducted an announced visit to the facility to conclude a complaint investigation. LPA met with Jessica Ramos, LVN, and discussed the purpose of the visit. Regarding the allegation, illegal eviction, it is alleged that the facility is illegally evicting resident #1 (R1) from the facility. LPA Malcore interviews with staff, residents, outside parties and record review reveal, there is not enough evidence to corroborate the allegation; Therefore, the allegation above is Unsubstantiated. An Unsubstantiated complaint means, that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted with LVN Ramos and a copy of this report with Appeal Rights was provided to LVN Ramos at the conclusion of the visit. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 25, 2024 · control 56-AS-20240318132655

Allegation investigated: Staff are not providing resident their medications as prescribed.

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to conduct a complaint investigation. LPA met with Jessica Ramos, LVN, and explained the purpose of the visit. Regarding the allegation, staff are not providing resident their medications as prescribed, it is alleged that staff are intentionally not providing resident with their medications. Six (6) staff interviewed deny not providing resident their medications as prescribed. Five (5) out of (6) residents interviewed stated that staff are providing their medications at prescribed. Based on evidence obtained during this investigation, the allegation above is Unsubstantiated; Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of this report was provided to Jessica Ramos at the conclusion of the visit. Unsubstantiatedthe state’s words, verbatim · CDSS document, Feb 26, 2024 · control 56-AS-20240221152527

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Jaclyn Nava, Administrator, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (64) and a current census of (50) residents in care. The facility has a hospice waiver for (10) residents. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant: Indoor and outdoor passageways are free of obstruction. The facility has no bodies of water accessible to residents in care. The facility has sufficient indoor and outdoor shaded areas for resident activities. The facility has sufficient lighting and is maintained at a comfortable temperature. Resident’s bathrooms inspected at random, were operating in safe and sanitary conditions. The hot water temperature in residents' bathrooms measured between 105 and 108 degrees F. Resident’s bedrooms inspected at random, have sufficient lighting and furniture in good repair. Facility has operating carbon monoxide alarms and telephone service. The facility has sufficient linen and personal care items for residents. The facility has posted in a common area, Community Care Licensing complaint poster, Ombudsman poster, evacuation plan, resident monthly activities and resident's personal rights. Food Service: Facility has sufficient non-perishable and perishable food supply for residents in care. The refrigerators and freezers are operating in a healthful manner. Pesticides and other cleaning solutions were kept locked and stored away from food areas. Care & Supervision: Facility has 24-hour, 7 days a week care staff. Record Review: The facility conducted a disaster drill on 9/21/2023. Resident files reviewed were observed to be complete. Review of staff files reveals, the facility did not maintain a health screening with tuberculosis results for staff #1 (S1). Medical Related Services: All medication is centrally stored and kept secure in a locked room. Based on LPA observations and record review, a deficiency is being cited per Title 22, Division 6 of The California Code of Regulations. An exit interview was conducted where reports LIC809/LIC809D/LIC9102 were discussed with the Administrator and copies of the reports with Appeal Rights were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jan 8, 2024

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced case management visit to follow-up on an incident reported to Community Care Licensing Division Regional office on 1/05/2024 by the facility. LPA met with Jaclyn Nava, Administrator and discussed the purpose of the visit. During today's, LPA obtained pertinent documentation and conducted interviews with resident #1(R1) and resident #2 (R2). The facility also conducted interviews with staff, residents involved and reported the incident that occurred on 1/03/2024 to the local Ombudsman and Sheriff department. No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and a copy of this report was provided to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jan 8, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to conduct a Health and Safety check to the facility. LPA met with Administrator Jaclyn Nava, and discussed the purpose of the visit. LPA Malcore observed no immediate health and safety concerns; However, Administrator Nava did not have an Administrator Certification. Administrator Nava provided LPA verification of Administrator course completion. Administrator Nava stated she will submit a Administrator Certification Application (LIC9214) today, 11/17/23. 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 where this report was discussed, and a copies of reports (LIC809/LIC809-D) with Appeal Rights were provided to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Nov 17, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87406(a) · Plan of correction due date: Nov 22, 2023

(a) All individuals shall be residential care facility for the elderly certificate holders prior to being employed as an administrator. This requirement is not met by: Licensee did not comply with the regulation cite by Administrator Nava did not have an Administrator Certification, which poses an potential health, safety, and personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Nov 17, 2023

Plan of correction: Licensee/Administrator shall provide verification of a certified and associated Administrator by POC due date.