Heritage Haven

Type of visit: Case Management - Other

On 7/22/2026 at 1:30 pm, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a case management visit to deliver amended report originally dated 7/16/2026. LPA met with Ferdinand Gutierrez, Administrator and informed him the reason for visit. LPA obtained the original report dated 7/16/2026 from the Administrator. No deficiencies are being cited on this date. Exit interview conducted with Ferdinand and a copy of this report providedthe state’s words, verbatim · CDSS document, Jul 22, 2026

Allegation investigated: Resident physicially assaulted another resident

***This is an amended report from visit on 7/16/2026*** On 7/16/2026 at 3:45 pm, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct an a complaint investigation and deliver findings in regards to the allegation above. LPA met with Ferdidnand Gutierrez, Administrator and informed the reason for visit. During investigation, LPA obtained and reviewed the resident roster and staff roster. LPA interviewed Staff (S1 and S2) and Residents (R1, R2, and R3). Allegation: Resident physicially assaulted another resident Finding: Unfounded Continue to LIC9099-C. Unfounded ***This is an amended report from visit on 7/16/2026*** Continued from LIC9099. During investigation, LPA interviewed staff and residents. Interviews with staff revealed that W2 has never been a resident at this facility before and they do not know who W2 is. S1 stated that W3 was a resident here around 2011 but was discharged over 3 years ago. S2 stated that they do not know W3. Staff stated that there have not been any recent incidents regarding resident altercations. Interviews with residents revealed that they do not know W2 or W3 and they have not witnessed any recent altercations between residents. No forthcoming information provided by reporting party. Therefore, LPA was unable to determine the details of alleged incident. This agency has investigated the complaint on the above allegation, we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint. No deficiency cited. Exit Interview conducted with Ferdinand and copy of this report provided.the state’s words, verbatim · CDSS document, Jul 16, 2026 · control 15-AS-20260707133535

Allegation investigated: Staff do not ensure the facility is free of hazards Staff do not ensure the facility is free of mold Staff do not ensure the facility is in good repair Staff do not provide adequate lighting for residents

On 7/1/2026 at 2:15 pm, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a continued complaint investigation and deliver findings for the allegations above. LPA met with Ancheta Rillera, Caregiver and explained the purpose of the visit. During the investigation, LPA reviewed the LIC500 (Personnel Report) and LIC9020 (Resident Roster). LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. LPA interviewed three (3) staff and four (4) residents. Allegation: Staff do not ensure the facility is free of hazards Finding: Substantiated Continued on LIC9099-C. Substantiated Continued from LIC9099. During Investigation, on 5/27/2026 and 7/1/2026, LPA toured the facility inside and out, including bedrooms, bathroom, living room, kitchen, dining area, garage and outside area. LPA observed drill bits and screwdriver bits in the upstairs restroom unlocked. LPA also observed Ez Patch Spackling Compound, Paint and Joint Compound unlocked in the downstairs restroom. LPA observed WD Spray, Clorox bleach and detergent unlocked in the garage. Allegation: Staff do not ensure the facility is free of mold Finding: Substantiated During Investigation, on 3/27/2026, 5/27/2026 and 7/1/2026, LPA toured the facilities resident bathrooms and LPA observed mold in the resident showers, bathtubs, and around the bottom of the toilets. Interview with staff revealed that there is mold in the residents restrooms in the showers, bathtubs and around the toilets. Staff stated that they clean everyday but it is difficult to remove the mold. Allegation: Staff do not ensure the facility is in good repair Finding: Substantiated During Investigation, on 3/27/2026, 5/27/2026 and 7/1/2026, LPA toured the facility inside and out, including bedrooms, bathroom, living room, kitchen, dining area, garage and outside area. LPA observed that the facility is currently under a construction plan to repair some items in the facility. LPA reviewed the construction contract and timeline and observed that there is no concrete deadline of completion. LPA observed that the construction contract they received from the facility is dated 9/25/2024. LPA observed that some of the items on the contract have not been completed. LPA observed that the light bulbs upstairs are damaged and not operable. Continue to LIC9099-C. Continued from LIC9099-C. Allegation: Staff do not provide adequate lighting for residents Finding: Substantiated During Investigation, on 3/27/2026, 5/27/2026 and 7/1/2026, LPA toured the facilities hallways and observed that the facility is using a single light strip in the resident hallway which is not adequate lighting for residents. LPA observed that multiple light fixtures are not operable in the upstairs hallways for the residents. Interview with residents and staff revealed that there are multiple light fixtures that are not operable in the facility. LPA observed the light bulb in the upstairs bathroom was not operable. Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Administrator verbally authorized Ancheta to sign today's report. Exit interview was conducted with Ancheta, Appeal Rights and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 1, 2026 · control 15-AS-20260319151737

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Jul 2, 2026

87309 Storage Space and Access (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions.. tools, sharp objects.. could pose a danger to residents.. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above drill bits, screwdriver bits, Ez Patch Spackling Compound, Paint and Joint Compound, WD Spray, Clorox bleach and detergent unlocked which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: By POC date, Licensee agrees to remove and put them in a locked cabinet and submit a self certification letter stating that this was completed to CCLD.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(1) · Plan of correction due date: Jul 8, 2026

87303 Maintenance and Operation (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in that the residents bathtub, showers and toilet had mold which poses a potential health and safety risk to persons in carethe state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: By POC date, Licensee agrees to have shower, bathtub and toilets deeply cleaned and the mold removed and submit photo proof that this was completed to CCLD.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jul 8, 2026

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in that the construction contract does not have a concrete timeline of completion and the light bulbs upstairs are non operable which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: By POC date, Licensee agrees to complete a detailed construction timeline with a completetion date and change the non operable lightbulbs and replace them with new lightbulbs and submit a copy of the construction timeline and self-certification letter stating that the light bulbs were changed to CCLD.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(d) · Plan of correction due date: Jul 8, 2026

87303 Maintenance and Operation (d) There shall be lamps or light appropriate for the use of each room and sufficient to ensure the comfort and safety of all persons in the facility This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in that the facility is using a single light strip in the resident hallway and multiple light fixtures are non operable which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: By POC date, Licensee agrees to remove the single light strip and replace the light fixtures and submit photo proof that this was completed to CCLD.

Type of visit: Case Management - Deficiencies

On 5/27/2026 at 5:30 pm, Licensing Program Analyst (LPA) Y. Brown and arrived unannounced to conduct a Case Management visit. LPA met with Administrator and explained the purpose of the visit. While LPA Y. Brown was conducting a complaint investigation (#15-AS-20260319151737) on 7/1/2026 it was revealed that: 1. Resident records were unavailable to licensing for inspection. The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted with Ancheta, a copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Jul 1, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(d) · Plan of correction due date: Jul 8, 2026

87506 Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours.. This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above in not having residents files available for licensing to review which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: By POC date, the Administrator agreed to review section 87506 and assign at least one staff member on shift to have access to resident files and submit a self certification letter to CCLD.

Type of visit: Case Management - Other

On 5/27/2026 at 4:40 pm, Licensing Program Analysts (LPAs) Y. Brown and K. Nguyen arrived unannounced to conduct a case management visit to deliver amended report originally dated 4/28/2026. LPA met with Ferdinand Gutierrez, Administrator and informed him the reason for visit. LPA obtained the original report dated 4/28/2026 from the Administrator. No deficiencies are being cited on this date. Exit interview conducted with Ferdinand and a copy of this report provided.the state’s words, verbatim · CDSS document, May 27, 2026

Type of visit: Case Management - Deficiencies

On 5/27/2026 at 5:30 pm, Licensing Program Analysts (LPAs) Y. Brown and K. Nguyen arrived unannounced to conduct a Case Management visit. LPA met with Administrator and explained the purpose of the visit. While LPA Y. Brown was conducting a complaint investigation (#15-AS-20260319151737) on 5/27/2026 during facility tour and interview LPA observed: 1. S1 was not fingerprint cleared and associated to the facility. The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted with Ferdinand Gutierrez and a copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, May 27, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 1569.17(c)(1)(A) · Plan of correction due date: May 28, 2026

(c)(1)(A) Subsequent to initial licensure, a person.. (b) who is not exempted from fingerprinting shall obtain.. (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment.. This requirement is not met as evidenced by: Based on observation, interview, the licensee did not comply with the section cited above in not having S1 fingerprinted and associated to the facility which poses an immediate health and safety risk to persons in carethe state’s words, verbatim · CDSS document, May 27, 2026

Plan of correction: By POC date, Licensee agreed to have S1 fingerprinted and associated to the facility and submit copy of fingerprint document to CCLD.

Allegation investigated: Facility not following reporting requirements

On 4/28/2026 at 11:00 am, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with Ferdinand Gutierrez, Administrator and explained the purpose of the visit. During the course of investigation, LPA obtained the following documents for R1 and R2: LIC602 (Medical Assessment), Identification and Emergency Contact, and Appraisal Needs and Services Plan. LPA obtained the following documents: Resident Roster and the LIC500 (Personnel Report) and R2's police report. LPA also conducted interviews with S1, S2, and S3. Continue on LIC9099-C. Substantiated Continued from LIC9099. Allegation: Facility not following reporting requirements Finding: Substantiated During interview and record review, LPA discovered that on 3/18/2026, the police conducted a visit at the facility to speak with R1 regarding R1's behavior at the facility. S1 stated that R1 was working with their case manager and now has been moved to a different facility. LPA reviewed an incident report regarding the situation that was sent to CCLD on 3/27/2026. Interviews with S1, S2, and S3 revealed that there were no other incident reports submitted to CCLD regarding the situation. Based on LPA information obtained during investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC9099D. Exit interview was conducted with Ferdinand, appeal rights and a copy of this report was provided. Continued from LIC9099. Allegation: Residents personal rights are being violated Finding: Unsubstantiated During interview and record review, LPA discovered that on 3/18/2026, the police conducted a visit at the facility to speak with R1 regarding R1's behavior at the facility. S1 stated that they have been working with R1's case manager about R1's increased behaviors. Interviews with S1, S2, and S3 revealed that R1 has been showing behaviors towards R2 such as yelling, screaming, and banging on the wall. Staff interviews revealed that R1 and R2 never had a physical or verbal altercation but R1 was displaying those behaviors towards R2 at the facility. S1 stated that R1 has now been moved to a different facility by their case manager. Based on interviews and record review during visit, the allegation that Residents personal rights are being violated was found to be unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency cited. Exit Interview conducted with Ferdinand and copy of this report provided.the state’s words, verbatim · CDSS document, Apr 28, 2026 · control 15-AS-20260325162814

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: May 5, 2026

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency...(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence... This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above in that an incident report was submitted 9 days after the incident occurred which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 28, 2026

Plan of correction: By POC date, the Administrator agrees to complete an all staff in-service retraining on reporting requirements and compliance with section 87211 and send proof of the in-service to CCLD.

Allegation investigated: Staff are not providing adequate supervision to the residents in care.

***This is an amended report from visit on 4/28/2026*** On 4/28/2026 at 9:25 AM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with Ferdinand G, Administrator and explained the purpose of the visit. During the course of investigation, LPA obtained the following documents for R1: LIC602 (Medical Assessment), Identification and Emergency Contact, Functional Capability and Appraisal Needs and Services Plan. LPA obtained the following documents: Resident Roster and the LIC500 (Personnel Report). LPA also conducted interviews with S1 and R1. Continue on LIC9099-C. Unsubstantiated ***This is an amended report from visit on 4/28/2026*** Continued from LIC9099. Allegation: Staff are not providing adequate supervision to the residents in care. Finding: Unsubstantiated During record review and interview, LPA discovered that R1 can leave the facility unassisted based on their LIC602 (Physicians report) dated 4/26/2023. S1 stated that R1 is able to leave the facility unassisted. S1 stated that they have previously spoken with the neighbors concerning R1’s behaviors in the community. S1 stated that they explained to the neighbors that R1 has behavioral disorders and the facility provides a space to help improve R1’s behaviors. S1 stated that they have been working with R1’s case manager to help improve R1’s behavior out in the community. R1 stated that there are always staff here to help assist them. R1 stated that they like to go out in the community. During visits on 4/7/2026 and 4/28/2026, LPA observed that there were two staff members working at the facility and there was sufficient staffing. Based on the investigation, which included interviews of 1 staff and 1 resident, and review of supervision log/sign in sheet, the allegation that Staff are not providing adequate supervision to the residents in care, is unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency cited. Exit Interview conducted with Ferdinand and copy of this report provided.the state’s words, verbatim · CDSS document, Apr 28, 2026 · control 15-AS-20260401142902

Allegation investigated: Staff are not providing adequate supervision to the residents in care.

***This is an amended report from visit on 4/28/2026*** On 4/28/2026 at 9:25 AM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with Ferdinand G, Administrator and explained the purpose of the visit. During the course of investigation, LPA obtained the following documents for R1: LIC602 (Medical Assessment), Identification and Emergency Contact, Functional Capability and Appraisal Needs and Services Plan. LPA obtained the following documents: Resident Roster and the LIC500 (Personnel Report). LPA also conducted interviews with S1 and R1. Continue on LIC9099-C. Unsubstantiated ***This is an amended report from visit on 4/28/2026*** Continued from LIC9099. Allegation: Staff are not providing adequate supervision to the residents in care. Finding: Unsubstantiated During record review and interview, LPA discovered that R1 can leave the facility unassisted based on their LIC602 (Physicians report) dated 4/26/2023. S1 stated that R1 is able to leave the facility unassisted. S1 stated that they have previously spoken with the neighbors concerning R1’s behaviors in the community. S1 stated that they explained to the neighbors that R1 has behavioral disorders and the facility provides a space to help improve R1’s behaviors. S1 stated that they have been working with R1’s case manager to help improve R1’s behavior out in the community. R1 stated that there are always staff here to help assist them. R1 stated that they like to go out in the community. During visits on 4/7/2026 and 4/28/2026, LPA observed that there were two staff members working at the facility and there was sufficient staffing. Based on the investigation, which included interviews of 1 staff and 1 resident, and review of supervision log/sign in sheet, the allegation that Staff are not providing adequate supervision to the residents in care, is unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency cited. Exit Interview conducted with Ferdinand and copy of this report provided.the state’s words, verbatim · CDSS document, Apr 28, 2026 · control 15-AS-20260401142902

Type of visit: Case Management - Other

On 4/28/2026 at 10:30 am, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a case management visit to deliver amended report originally dated 3/27/2026. LPA met with Ferdinand Gutierrez, Administrator and informed him the reason for visit. LPA obtained the original report dated 3/27/2026 from the Administrator. No deficiencies are being cited on this date. Exit interview conducted with Ferdinand and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 28, 2026

Type of visit: Case Management - Other

On 3/27/2026 at 12:30 PM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a Case Management visit. LPA met with Ferdinand Gutierrez, Administrator and explained the purpose of the visit. Licensee Jene Snipes accompanied the discussion via telephone. During the visit, LPA, Administrator and Licensee discussed the update on the construction timeline and the delay of the funding. Licensee stated that there has been a delay in the construction timeline due to the City of San Leandro sending revisions to the permits. Licensee stated that they are waiting for the City to give a date on the next inspection. Licensee stated that minor construction is getting done at this time but there is a delay in funding. Exit interview conducted with Ferdinand and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 27, 2026

Type of visit: Required - 1 Year

On 2/17/2026 at 10:30 AM, Licensing Program Analyst (LPA) Y. Brown conducted an unannounced annual 1-year required inspection. LPA met with Administrator Ferdinand Gutierrez and explained the purpose of the visit. The administrator currently holds a certificate (#7006076740) that expires on 10/4/2026. The facility’s fire clearance was approved for twenty-seven (27) ambulatory residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. All indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for residents is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Hot water temperature in the facilities kitchen was measured at 120 degrees Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for residents. Smoke detectors and carbon monoxide combination were in operating condition during visit. First aid kit was observed to be complete. LPA reviewed five (5) staff and six (6) resident records. LPA reviewed a sample of medication. Continued on LIC809C. (Continued from LIC809...) The following forms will be updated and submitted to CCLD by 2/24/2026: LIC610D: Emergency disaster plan (last page) LIC500: (Personnel Record) Liability Insurance The following deficiencies were observed: At 11:15 am, LPA observed that S3 did not have a Health Screening/Negative TB. At 11:30 am, LPA observed that S2, S3, S4, and S5 had missing required 20 hr annual training At 12:00 pm, LPA observed that R1, R3, and R4 did not have updated Appraisal Needs and Services Plans At 1:00 pm, LPA observed that 2 out of 2 fire extinguishers were expired. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted with Ferdinand. A copy of the appeal rights and this report provided.the state’s words, verbatim · CDSS document, Feb 17, 2026

Type of visit: POC

On 8/4/2025 at 10:00 am, Licensing Program Analysts (LPAs) Y. Brown and J. Sampair arrived unannounced to conduct a plan of correction (POC) visit. LPAs met with Administrator Ferdinand Gutierrez and explained the purpose of the visit. LPAs toured the facility including but not limited to resident's bedrooms, bathrooms, common area, kitchen, garage and outdoor area. LPAs discussed next plans for repairs that are needed within the facility as per 2/14/2024 POCs. Administrator will send a plan over to LPAs that details how residents will be accommodated during the construction at the facility by 8/11/2025. No deficiency issue on today date. Exit interview conducted and a copy of this report is provided.the state’s words, verbatim · CDSS document, Aug 4, 2025

Type of visit: Case Management - Annual Continuation

On February 12, at 8:30 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct a continuation of the Annual Inspection began on January 29, 2025. Upon arrival, LPA stated the purpose of the visit to Caregiver Laila Deguzman. Administrator Ferdinand Gutierrez joined the LPA at approximately 8:45 AM. The LPA reviewed 5 staff records and 5 resident records. The LPA completed the annual inspection. 1 B-Type Citation issued (for details refer to LIC 809-D). Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 12, 2025

Type of visit: Required - 1 Year

On 1/29/2025 at 7:30 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct a Plan of Correction (POC) visit. Upon arrival, LPA stated the purpose of the visit to Caregiver Laila Deguzman. Administrator Ferdinand Gutierrez joined the LPA at approximately 8:45 AM. The LPA toured the facility inside and outside with the Caregiver and the Administrator. The LPA observed that the smoke detectors have been installed and functioning, but the physical plant remains in disrepair. The LPA and Administrator spoke with the Licensee Jene Snipe over the phone who stated that the work on the physical plant has again been delayed because the distribution of the money they are receiving from Alameda County to pay for the repairs will not be available until March of 2025. Fire extinguishers were last serviced on 1/6/2025. No citations issued. Required Annual Inspection incomplete. LPA shall return unannounced to complete the inspection at a later date and time. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 29, 2025

Type of visit: POC

On 1/29/2025 at 7:30 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct a Plan of Correction (POC) visit. Upon arrival, LPA stated the purpose of the visit to Caregiver Laila Deguzman. Administrator Ferdinand Gutierrez joined the LPA at approximately 8:45 AM. The LPA toured the facility inside and outside with the Caregiver and the Administrator. The LPA observed that the smoke detectors have been installed and functioning, but the physical plant remains in disrepair. The LPA and Administrator spoke with the Licensee Jene Snipe over the phone who stated that the work on the physical plant has again been delayed because the distribution of the money they are receiving from Alameda County to pay for the repairs will not be available until March of 2025. No citations issued. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 29, 2025

Type of visit: Case Management - Incident

On 01/14/2025 at 1:50 PM Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced Case Management visit regarding information obtained that a resident was missing from an Unusual Incident Report (UIR) received on 1/6/2025. LPA met with Administrator, Ferdinand Gutierrez and explained the purpose of the visit. LPA K. Nguyen interviewed S1 that confirmed that R1 was missing on 1/03/2025 and returned back to the facility on 01/07/2025. S1 stated that R1 leaves almost every day since R1 were admitted which was 08/5/2024. However, on this particular day, R1 did not return. S1 stated that R1 went to see R1 husband in Oakland without informing any staff. R1 had a court order that R1 husband are not to be near R1, and R1 husband are not supposed to be at the facility as well. S1 stated that R1 is trying to find ways to see R1 husband. We cannot stop R1 from leaving the facility. LPA interviewed R1 and R1 stated that R1 went to see R1 husband because R1 haven’t seen R1 husband for 3 months. R1 stay at R1 husband house, and R1 husband brought R1 back to the facility. R1's Physician's Report indicates that R1 are able to leave the facility unassisted. LPA reviewed R1 files and confirmed R1 physician report that R1 is able to leave the facility unassisted. No deficiency issue on today date. Exit interview conducted and a copy of this report is provided.the state’s words, verbatim · CDSS document, Jan 14, 2025

Type of visit: POC

On 10/17/2024 at 11:05 am Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Plan of Correction (POC) visit regarding Case Management visit on 09/10/2024. LPA met with Administrator, Ferdinand Gutierrez and explained the purpose of the visit. On 09/10/2024, LPA conducted an Case Management visit in which deficiency were cited. The POC due date was 10/08/2024. Deficiency not cleared during visit: 87466 $100.00 x 9 Days = $900.00 Civil Penalties in the total amount of $900.00 is assessed today for failure to meet POC date for deficiency. Facility is subject to ongoing daily civil penalties until deficiency is corrected. Exit interview conducted. A copy of this report, appeal rights provided and LIC421FC provided.the state’s words, verbatim · CDSS document, Oct 17, 2024

Type of visit: Case Management - Other

On 09/10/2024 at 1:20 PM Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Case Management visit regarding information obtained that a resident was missing. LPA met with Administrator, Ferdinand Gutierrez and explained the purpose of the visit. LPA L. Alexander interviewed S1 that confirmed that R1 was missing on 09/05/2024 and returned back to the facility on 09/06/2024. S1 stated that R1 leaves almost everyday since they were admitted which was 08/13/2024. However, on this particular day, R1 did not return. S1 stated that R1 got lost. LPA interviewed R1 and R1 stated that they got lost but came back to the facility on the bus. R1's Physician's Report indicates that they are able to leave the facility unassisted. S1 stated that they will send an incident report via e-mail to Community Care Licensing (CCLD). LPA L. Alexander collected the following documents: Current Resident Roster and R1's Physician's Report. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights providedthe state’s words, verbatim · CDSS document, Sep 10, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: Oct 8, 2024

87466 Observation of the Resident..The licensee shall ensure that residents are regularly 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: Based on interview, the licensee did not comply with the section above for not doing an updated reappraisal with the changes in R1 getting lost when leaving the facility. This posed a potential health and safety risk to person in care.the state’s words, verbatim · CDSS document, Sep 10, 2024

Plan of correction: Administrator will do an reappraisal with R1's physician and submit an updated re-appraisal and Physician's Report to CCLD by POC date.

Type of visit: Required - 1 Year

On 02/14/2024 at 12:45 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct a required annual inspection. LPA explained the purpose of the visit to Administrator (ADM) Ferdinand Gutierrez. LPA toured the interior and exterior of the facility. LPA inspected the kitchen, dining area, restrooms, community living spaces, bathrooms, resident rooms, and the grounds of the facility. 2 days of perishable and 7 days of non-perishable foods on hand. A complaint poster, Ombudsman and Personal Rights posters, Theft and Loss Policy, Rights to Resident Council and Rights to Family Council were observed posted in a prominent location. Fire extinguishers were last serviced on 8/11/2023. Temperature in the facility was measured at 74.8 degrees in the dining room at 4:35 PM. 7 B-Type citations issued during inspection. Required Annual Inspection incomplete. LPA shall return unannounced to complete the inspection at a later date and time. Exit interview conducted with ADM and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Feb 14, 2024