Highlands Care Home IV

Allegation investigated: Lack of Supervision Personal Rights

At approximately 12:20PM Licensing Program Analyst (LPA) Magdaleno arrived unannounced to deliver findings regarding the above allegations and met with Caregiver Lolita Pimental. Administrator Maria Salvador was contact via telephone and gave permission for caregiver to sign and receive report. Lack of Supervision, Personal Rights - Complaint alleges that due to lack of supervision, residents were using illegal drugs in the facility and at least one resident was providing drugs to at least another resident. Alleged activity resulted in resident eloping from the facility due to another resident requesting money from them to buy drugs. Three of four residents interviews denied drug use in the home while the fourth resident did not answer the question. A fifth resident refused to be interviewed. Two of three staff interviewed reported suspicions that residents were using drugs in the home but denied seeing drugs being used in the home. Review of Plan of Operation and Facility Policies indicated that potential risks to resident health and safety shall be reported. Continued LIC9099C... Unsubstantiated Continued from LIC9099... Staff reported that they don’t have a policy for how often residents are checked on. Although the allegations may have happened or are valid, the Department has found there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated. Exit interview conducted with Caregiver, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Aug 20, 2026 · control 21-AS-20260423131419

Type of visit: Case Management - Other

At approximately 12:20PM Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a case management - other visit and met with Caregiver Lolita Pimental. Administrator Maria Salvador was contact via telephone and gave permission for caregiver to sign and receive report. The purpose of this visit was to cite deficiencies found during investigation of complaint 21-AS-20260423131419. Review of facility Plan of Operation and Facility Policies indicated that potential risks to resident health and safety shall be reported. Interviews with staff indicated there was a suspicion of drug use in the facility due to observed changes in resident behaviors, changes in residents relationships, and suspicions from other residents. These potential risks were not elevated and there was no increase in residents checks nor were updated appraisals conducted. Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights were provided. See LIC809D. Exit interview conducted with Caregiver, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Aug 20, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208 · Plan of correction due date: Sep 18, 2026

87208(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so… This requirement not met by licensee as evidenced by: Staff did not report potential health and safety risks to residents in care as stipulated by Plan of Operation which poses/posed a potential risk to the Health and Safety of residents in care.the state’s words, verbatim · CDSS document, Aug 20, 2026

Plan of correction: Licensee shall submit proof of staff training regarding facility policies by Plan of Correction due date of 09/18/2026 by 5:00PM.

Type of visit: Required - 1 Year

At approximately 9:55AM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a required 1-year annual inspection and met with Caregiver Lolita Pimentel. Assistant Administrator Christianne Salvador was called and gave permission for caregiver to sign and receive report. Facility is a Residential Care Facility for the Elderly (RCFE) with five (5) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for one (1), with zero (0) Hospice residents currently in care, and is approved for all non-ambulatory residents. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 10:20AM, LPA initiated a tour of the facility with Caregiver and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Facility's fire extinguisher was observed charged and last serviced 2/26. Combination Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 106.3 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. Additional bathroom was being renovated during this visit with a same day estimated completion time. LPA reminded caregiver that Community Care Licensing shall be informed of renovations/construction in order to ensure resident safety. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed one unlocked shed in the backyard which contained old supplies. There is a shaded seating area in the backyard with outdoor space for activities, however, facility back porch had old bathroom appliances that will be taken by construction crew upon construction finish. Continued LIC809C... Continued from LIC809... LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Caregiver was reminded of the importance of checking fresh foods. Facility has an internet access device and internet available to residents in care, and the phone was observed operational during today's inspection. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 10:55AM LPA conducted a review of three (3) staff records. No deficiency cited. At approximately 11:15AM LPA conducted a review of five (5) resident records. No deficiency cited. At approximately 11:40AM LPA and Caregiver conducted a spot check of medication and medication records. Medication is centrally stored and locked. Maria Salvador Administrator Certificate 7004161740 expires 03/21/2028. Updated copies of the following documents shall be submitted to CCL by 6/19/2026: Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Caregiver, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, May 21, 2026

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 - Other

Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a Case Management - Other visit and met with Assistant Administrator Christianne Salvador. This visit was to conduct a follow up and gather more information regarding an Incident Report (IR) submitted by the facility on 4/3/2026. The incident report detailed a resident (R1) who eloped from the facility on 4/3/2026 afternoon. Per interviews, R1 was taken to the hospital on 4/3/2026 and after further outings with staff, returned and went into their room. Staff later discovered R1 had left the facility without staff knowledge and has not returned as of the date of this visit. Review of most recent LIC602-Physicians Report dated 1/2023 indicated that R1 is not able to leave facility unassisted. Review of R1 Care Plan dated 1/26 indicated R1 is very independent and review of Conservatorship Paperwork dated 10/25 indicated R1 has had their conservator lifted. Interviews with staff indicated R1 has not shown elopement behaviors at this facility, however, R1 does have a history of elopement from previous facilities. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. See LIC809D. Appeal rights were provided. Additional civil penalties may be assessed based on Health and Safety Code 1569.49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f).** Exit interview conducted with Assistant Administrator, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Apr 16, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Apr 17, 2026

87411(a) Personnel Requirements - General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidence by: Based on incident report and interview, facility did not provide supervision to R1 resulting in an elopement. The absence/lack of supervision is an immediate risk to the Health, Safety and Rights of resident in care.the state’s words, verbatim · CDSS document, Apr 16, 2026

Plan of correction: Licensee shall plan to CCL by 4/17/2026 re: conducting ongoing in-service training about elopement procedures as well as updating resident assessment upon change of condition.

Type of visit: Required - 1 Year

At approximately 12:50 PM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Caregiver. Administrator Maria Salvador was unavailable and Assistant Administrator (AA) Christine Salvador was sent to sign report. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. At time of visit, three (3) residents were present with the rest at day program. Facility has a Dementia Care Plan, a Hospice waiver for one (1), with zero (0) Hospice residents currently in care, and is approved for all non-ambulatory residents. At approximately 1:15 PM, LPA initiated a tour of the facility with Caregiver and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 3/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 112.4 degrees F and 105.9 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered, as well as an emergency water supply. There is a seating area in the backyard with outdoor space for activities. LPA observed one locked shed in the backyard which acts as additional storage. Facility has an internet access device designated for resident use and internet service available. Facility telephone was tested and operational during inspection. Continued 809C... Continued from 809... At approximately 2:00 PM LPA conducted a review of three (3) resident records. All required documentation present. At approximately 2:30 PM LPA conducted review of three (3) staff records. All required documentation present. At approximately 2:45 PM LPA and Caregiver conducted a spot check of medication and medication records. Medication is centrally stored and locked. Maria Salvador Administrator Certificate 7004161740 expires 3/21/2026. All fees are current as of this time. LPA and Administrator discussed facility's Emergency Disaster plan, last updated 2/25. Facility’s last quarterly disaster drill was conducted on 10/24. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC610D - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Administrator and a copy of this report was given. Exit interview conducted with Assistant Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Apr 28, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff do not safeguard resident's cash resources

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to deliver findings for complaint 21-AS-20240509122719 at Highlands Care Home IV on 05/29/2024. LPA met with Lolita Pimentel, House Manager. The complaint alleges that Staff do not safeguard resident's cash resources. During the investigation, LPA verified that Client (C1) is able to manage their own cash resources. LPA reviewed records, conducted interviews and made observations. Upon review of the evidence, the Department found that an individual not employed with the facility had access to/possession of C1’s EBT card. Continued 9099-C... Unsubstantiated Continued from 9099.... It was reported to the facility and county officials that C1’s funds were reduced while not in C1’s possession. It was later learned that the alleged abuse occurred by an outside individual and not facility staff who had obtained the EBT card without facility or staff knowledge. Therefore, due to the facility staff not having possession, control or access to the EBT card, and C1 able to manage their own cash resources, the allegation that Staff do not safeguard the resident’s cash resources is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.the state’s words, verbatim · CDSS document, May 29, 2024 · control 21-AS-20240509122719

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual Inspection and to deliver findings to a complaint investigation. LPA was allowed entry by House Manager Lolita Pimentel. The facility currently provides care for six (6) residents, one (1) is receiving hospice services. Three (3) of the residents were attending Day Program at the time of inspection and the other three (3) were on site. LPA toured the facility with House Manager; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Residents' bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers were found to be last charged on 3/28/2024. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored securely in designated staff quarters and garage. There was a supply of cleaners, hygiene products and paper products available for residents. All resident bedrooms have lighting & appropriate furnishings. LPA tested smoke alarms and were all found to be in working order. Medication is stored in a secured cabinet located in the kitchen along with medication records. A spot medication count was conducted and both records and administration review found to be in order. Hot water measured at 109 degrees F and 111 degrees F in the two (2) bathrooms which is within Title 22 regulations of 105 to 120 degrees F in faucets used by residents. Continued on 809-C Continued from 809..... LPA conducted a review of staff records and confirmed that all staff have updated 1st Aid & CPR Training on file. Upon review of training records, LPA found that 5 out of 5 staff had the required annual training. Last training was conducted in March 2024. 5 out of 5 client files were found to be complete. LPA requested the following documents: LIC500 Resident Roster No deficiencies were found at the time of inspection. No citations issued.the state’s words, verbatim · CDSS document, May 29, 2024