Hm Love & Care Home

Type of visit: POC

On this day, 9/02/26, Licensing Program Analyst (LPA) Delmundo conducted Proof of Correction (POC) visit. On 5/05/26, LPA conducted investigation of a complaint (15-AS-20260427120706) and issued citations for deficiency section #s 87244(a)(1) and 1569.655(a) with POCs to be submitted by 5/19/26. On that same day, LPA also issued citation under case management for section # 87307(a) with POC due by 5/20/26. POCs were not submitted. Deficiencies are re-cited and listed on 809Ds. Failure to submit proof of corrections (POCs) by plan of correction due dates and any repeat violation within 12 month period may result in civil penalty. Deficiencies and plan and proof corrections were discussed with LIC-ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form, and copy of this report provided.the state’s words, verbatim · CDSS document, Sep 2, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a)(1) · Plan of correction due date: Sep 16, 2026

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident..... (1) Nonpayment of the rate for basic services within ten days of the due date. -This requirement is not met as evidence by: -Based on interviews and record review, the licensee did not comply with the section above in incorporating eviction for non-payment to the rate increase notification which poses a potential rights risks to persons in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: Licensee-administrator to read the Regulations and self-certify full understanding. Proof to be submitted by 9/16/26.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.655(a) · Plan of correction due date: Sep 16, 2026

§1569.655 Increase in fee rates for elderly residents; 90 days’ written notice... (a) .... the licensee shall provide no less than 90 days’ prior written notice to the residents or the residents’representatives setting forth the amount of the increase and the reason or reasons for the increase, including a ...... ....description of the additional costs.... -This requirement is not met as evidence by: -Based on interviews and record review, the licensee did not comply with the section above in giving a written notification for increase to R1 16 days after the date on the letter and does not include description of the addtional costs for increase.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: Licensee-administrator to correct and rewrite the notification. Copy to be submitted by 9/16/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a) · Plan of correction due date: Sep 16, 2026

87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. ........ -This requirement is not met as evidenced by -Based on observation and interview, the licensee did not comply with the section above in having R1's personal and confidential documents and medications stacked in the dining table which pose a potential personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: Corrected. On this day, 9/02/26, LPA observed all of R1's personal belongings were removed from the dining table.

Type of visit: Case Management - Deficiencies

While at the facility conducting investigation of a complaint (15-AS-20260831130630) and upon review of residents' records and inspection, Licensing Program Analyst (LPA) Delmundo observed the following which LPA discussed with Licensee-Administrator (LIC-ADM) Maria Riformo. at 12:47 pm, medications and vitamins in Resident R1's room. R1 was not at the facility and R1's room was not locked. Resident R2's medical assessment (LIC602A Physician's Report) indicated R2 has major neurocognitive disease and the LIC602A is over 2 years old and no LIC625 Appraisal/Needs and Services Plan on file. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. Failure to submit proof of corrections (POCs) by plan of correction due dates and any repeat violation within 12 month period may result in civil penalty. Deficiencies and plan and proof corrections were discussed with LIC-ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form, and copy of this report provided.the state’s words, verbatim · CDSS document, Sep 2, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(1)(C) · Plan of correction due date: Sep 3, 2026

87465 Incidental Medical and Dental Care: (h) (1) Medications shall be centrally stored under the following circumstances:(C) Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the... facility, the medications are determined ...to be a safety hazard to others. -This requirement is not met as evidenced by: -Based on observation, the licensee did not comply with the section above in medications and vitamins in R1's unlocked room which pose an immediate health and/or safety risks to persons in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: LIC-ADM locked the medications and vitamins in central storage for medications. In addtition, LIC-ADM to in-service the staff and submit proof by 9/03/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(h) · Plan of correction due date: Sep 16, 2026

87463 Reappraisals (h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. -This requirement is not met as evidenced by: -Based on record review, the licensee did not comply with the section above in R2's medical assessment over 2 years old which poses a potential health and/or personal rights risks to person in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: LIC-ADM stated she'll have the resident medically assessed. Copy of LIC602A to be submitted by 9/16/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463(a) · Plan of correction due date: Sep 16, 2026

87463 Reappraisals: (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in conditiion....... .........and to keep the appraisal accurate. -This requirement is not met as evidenced by: -Based on records review, the licensee did not comply with the section above in R2 not having reappraisal which poses a potential health, safety and/or personal rights risks to person in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: LIC-ADM stated she'll do the reappraisal. Copy of LIC625 to be submitted by 9/16/26.

Type of visit: Required - 1 Year

On 8/26/2026 Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced 1-year required visit. LPA met and toured with Maria Riformo. Administrator. The Administrator currently holds a certificate (#7001621740) that expires on 04/06/2027. LPA and Licensee toured the facility including, but not limited to common areas, bathrooms, bedrooms, kitchen, and backyard. LPA observed mask, cough etiquette, social distancing and hand washing signs posted throughout. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All hand washing stations were equipped with soap, paper towels and garbage cans. The hot water temperature in the shared residents' bathroom measured at 101.8 degrees Fahrenheit (F) and the facility's temperature was 75 degrees F. Smoke/Carbon Monoxide detectors were observed operational and first aid kit complete. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher did not have tags. Emergency Disaster Plan was last posted on 07/18/2026. First aid kit was observed to be incomplete. Report continues on 809C. CONTINUE FROM LIC 809 LPA reviewed two (2) staff record files; which were not complete. LPA reviewed three (2) clients' files; all were complete. LPA observed the following deficiencies: - at 11:16 AM. LPA observed resident room #1 with unlocked medications and vitamins. - at 11:22 AM. LPA observed pre-poured medication on kitchen table. - at 11:24 AM, LPA observed fabuloso unlocked under bathroom sink. - at 11:25 AM, LPA observed in resident room WD-40, scissors, screwdriver. - at 11:31 AM, LPA observed unlocked medication box in the refrigerator with insulin. - at 11:33, AM, LPA observed 2 fire extinguishers with no tags or receipts. - at 11:34, AM, LPA observed knives, scissors, matches, fire place lighter, all unlocked in the kitchen. - at 11:45, AM, LPA observed unlocked garage which has laundry soap, chemicals, lawn mower, hedge trimmers, and other tools in the garage. - at 12:59, PM, LPA observed that no staff has a current CPR/First-Aid certificate. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. The following forms to be updated and submitted to CCL by 09/04/2026: LIC 500 Personnel Report LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 610E Emergency Disaster Plan Liability Insurance Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 26, 2026

Allegation investigated: Illegal eviction. Staff increased resident's rates without 90 day written notice.

On this day, May 5, 2026. at 10:55 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegations. LPA was granted entry by staff, Manolo Boado. LPA spoke over the phone with Maria Riformo, licensee-administrator (LIC-ADM), who arrived after about 15 minutes. LPA reviewed residents' records and obtained copies of following documents: LIC601 Identification and Emergency Contact Information; Admission Agreement; LIC602A Physician's Report; rate increase notification. LPA conducted interviews: ....continued on 9099C Substantiated Allegation: Illegal eviction. Allegation: Staff increased resident's rates without 90 day written notice. R1 stated the licensee gave R1 written notification for rate increase dated April 15, 2026 that if R1 cannot add the amount of increase to the rent, a 60 days notice to relocate to another place is included on the written notification. The licensee-administrator (LIC-ADM) confirmed what R1 stated. LIC-ADM also stated she gave written notification on May 1, 2026. Review of the written notification showed it was dated April 15, 2026 with effective date July 15, 2026 with reason for increase is due to cost of living getting more expensive but does not include description of the additional costs. Based on review of records and interviews, the above allegations are substantiated. A finding that a complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies are cited from Title 22 California Code of Regulations and listed on 9099D. Failure to submit proof of corrections (POCs) by plan of correction due dates and any repeat violation within 12 month period may result in civil penalty. Deficiencies and plan and proof corrections were discussed with LIC-ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form, and copy of this report provided.the state’s words, verbatim · CDSS document, May 5, 2026 · control 15-AS-20260427120706

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a)(1) · Plan of correction due date: May 19, 2026

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident..... (1) Nonpayment of the rate for basic services within ten days of the due date. -This requirement is not met as evidence by: -Based on interviews and record review, the licensee did not comply with the section above in incorporating eviction for non-payment to the rate increase notification which poses a potential rights risks to persons in care.the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: Licensee-administrator to read the Regulations and self-certify full understanding. Proof to be submitted by 5/19/26.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655(a) · Plan of correction due date: May 19, 2026

§1569.655 Increase in fee rates for elderly residents; 90 days’ written notice... (a) .... the licensee shall provide no less than 90 days’ prior written notice to the residents or the residents’representatives setting forth the amount of the increase and the reason or reasons for the increase, including a ...... ....description of the additional costs.... -This requirement is not met as evidence by: -Based on interviews and record review, the licensee did not comply with the section above in giving a written notification for increase to R1 16 days after the date on the letter and does not include description of the addtional costs for increase.the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: Licensee-administrator stated she will correct and rewrite the notification. Copy to be submitted by 5/19/26.

Type of visit: Case Management - Deficiencies

On this day, May 5, 2026, while at the facility investigating a complaint (Control # 15-AS-20260427120706), LPA observed the following: 1. Resident's (R1) medications in the dining table. 2. Resident's (R1) personal and confidential documents stacked in the dining table. 3. Used lancets not property stored and in the dining tablet. Used syringes and other used lancets in unlocked cabinet. The above observations were discussed with Maria Riformo, licensee-administrator (LIC-ADM). Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. Failure to submit proof of corrections (POCs) by plan of correction due dates and any repeat violation within 12 month period may result in civil penalty. Deficiencies and plan and proof corrections were discussed with LIC-ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form, and copy of this report provided.the state’s words, verbatim · CDSS document, May 5, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(1)(C) · Plan of correction due date: May 6, 2026

87465 Incidental Medical and Dental Care: (h) ...: (1) Medications shall be centrally stored under the following circumstances: (C) Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the...... ..facility, the medications are determined by either a physician, the administrator, or Department to be a safety hazard to others. -This requirement is not met as evidenced by: -Based on observation, the licensee did not comply with the section above in R1's medications in the dining table which pose an immediate risks to persons in care.the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: Staff removed the medications. In addition, licensee-administrator stated she'll buy and provide a lock box to R1. Proof to be submitted by 5/06/26.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87303(f)(2) · Plan of correction due date: May 6, 2026

87303 Maintenance and Operation (f) All waste shall be located, stored, and disposed of in a manner that will not transmit communicable diseases...... (2) Syringes and needles are disposed of in accordance with the California Code of Regulations, Title 8, Section 5193...... -This requirement is not met as evidenced by: -Based on observation, the licensee did not comply with the section above in used lancets in the dining table and used syringes and other lancets in unlocked cabinet which pose an immediate risks to persons in care.the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: Licensee-administrator took all the items and stated she will properly disposed them. In addition, licensee-administrator to in-service the staff and submit copy of training topic with attendees signatures by 5/06/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a) · Plan of correction due date: May 20, 2026

87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. ........ -This requirement is not met as evidenced by: -Based on observation and interview, the licensee did not comply with the section above in having R1's personal and confidential documents and medications stacked in the dining table which pose a potential personal rights risks to persons in care.the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: Staff removed the medications. In addition, licensee-administrator will put cabinet/drawer in the resident's room and have all the items in the dining table transfered. Pictures to be submitted by 5/20/26.

Type of visit: Required - 1 Year

On 07/02/25 around 10:25 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required annual inspection. LPA was greeted by one staff upon entry and explained the purpose of the visit. Maria Riformo, Administrator (Licensee) arrived about 10 minutes later who currently holds a standard certificate (#7001621740) exp. 04/06/25. The facility’s fire clearance was approved for six (6), four (4) may be non-ambulatory residents. Upon entry, LPA observed one (1) resident in the dining area having a telephone conversation. LPA and Licensee toured the facility including, but not limited to common areas, bathrooms, bedrooms, kitchen, and backyard. LPA observed mask, cough etiquette, social distancing and hand washing signs posted throughout. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All hand washing stations were equipped with soap, paper towels and garbage cans. The hot water temperature in the shared residents' bathroom measured at 105.3 degrees Fahrenheit (F) and the facility's temperature was 68 degrees F. Smoke/Carbon Monoxide detectors were observed operational and first aid kit complete. continued on LIC809C... ...continued from LIC809. Fire extinguisher was observed full and tagged with receipt and expires 07/05/24. Emergency Disaster Plan is updated. Last safety drill conducted 03/08/25 and is rotational between AM and PM schedules quarterly. LPA reviewed three (3) staff files with criminal record clearances, and three (3) resident files; all files were incomplete. -At 11:30 AM: Facility Administrator records have not been updated with CCLD. -At 11:35 AM: Residents files are not updated with a current Appraisal Needs and Services Plan. -At 11:35 AM: Personnel files are not updated with Heath Screening, TB testing and Training records. -At 12:20 PM: PUB 475 regulatory size not posted in the facility. The following forms are to be updated and submitted to CCLD by 07/23/25: -Resident Roster (Reviewed) -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility -LIC610 Emergency Disaster Plan (Reviewed) -Administrator Certificate(s) (Reviewed) -Infection Control Plan (Reviewed) -Liability Insurance (Reviewed) -Written plan for repairing or removing the patio lattice. Exit interview conducted and a copy of this report provided to Maria Riformo, Licensee.the state’s words, verbatim · CDSS document, Jul 2, 2025

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

On 01/30/2025 around 04:45 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a Case Management visit to confirm that an Administrator was on site. LPA met with care staff and Maria Riformo, Licensee (S1) arrived about 10 minutes later. On 11/01/2024, LPA L. Hall conducted a complaint investigation for 15-AS-20230901131403. At that time, LPA L. Hall observed that the Administrator on record did not have a valid Standard Certified. A deficiency was cited from the California Code of Regulations, Title 22. On 01/07/25, S1 emailed LPA. L. Holmes stating S1 was in the process of completing all the documents and information regarding the change of administrator. LPA L. Holmes reviewed S2 records, and confirmed with CCLD that S2's application was processed and is pending effective 11/18/2024. S1 holds a Standard Certificate 60066016740 exp. 04/06/2025 and will act as the administrator only until the S2's certificate is approved and will provide proof to CCLD. Exit interview conducted and a copy of this report provided to S1.the state’s words, verbatim · CDSS document, Jan 30, 2025

Allegation investigated: Resident is not provided with clean bed linen Staff do not assist resident with grooming

On 11/1/2024 at 2:05pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver complaint findings for the allegations above. LPA met with Maria Riformo, Licensee and explained the reason for the visit. The Department interviewed the reporting party (RP), staff, obtained and reviewed records. Allegation: Resident is not provided with clean bed linen. During interview with RP it was sated that R1’s bed did not have a blanket and the fitted sheet was stained. During interview with S1 it was stated linens are changed Continued on LIC9099C. Substantiated Continued from LIC9099. once a week or as often as needed. Based on observation, besides the sheets that were on the beds, the facility owned five (5) fitted sheets, several flat sheets, and two (2) of the fitted sheets was for a bed size that wasn’t present at the facility. LPA observed one (1) sheet that was stained and had to be discarded. Allegation: Staff do not assist resident with grooming R1 was admitted into the facility 2/13/2013. Review of the admission agreement indicated that at the time of admission R1 was able to self-groom. RP stated during interview that R1’s hair was not washed and R1 was wearing a dirty shirt. On the functional capability assessment and the appraisal needs and services plan dated 8/2/2023 it indicated R1 was not capable of self-grooming. S1 stated that a caregiver would groom R1. LPA reviewed pictures that were submitted and observed R1’s nails were long and had dirt underneath. The pictures also displayed R1’s hair unkempt. Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted. A copy of the appeal rights and this report provided. Continued from LIC9099. Costa Regional Medical Center dated 7/31/2023 indicates bruising but not from abuse or neglect. Allegation: Staff do not meet residents' dietary needs. During initial interview with RP it was stated that R1 had lost a significant amount of weight between 2020-2023. S1 stated a weight loss log is not kept unless it is noticeable. Review of the physician’s report dated 09/27/2019 did not have R1’s weight listed but did state that R1 was a 2000 ADA calorie diet. Allegation: Staff do not assist resident with bathing Based on initial interview with RP it was stated R1 was wearing a dirty shirt, hair was not washed, and she was unkempt. S1 stated that R1 was given a bath every other day and more if needed. Allegation: Facility is not maintained clean and sanitary at all times On 6/16/2023, the RP visited the facility and stated during interview the floors were “dirty”. Pictures with unknown dates were also submitted showing the floor underneath a bed was unsanitary. LPA L. Holmes toured the facility during visit on 8/02/2023 and observed the facility to be sanitary. Allegation: Staff do not allow resident to keep and use their own personal possessions During record review it indicated that on the functional capability assessment and the appraisal needs and services plan dated 8/2/2023 that R1 is not capable of self-grooming. RP stated a brush was requested for R1 and staff brought a Continued on LIC9099C. Continued from LIC9099C. “community brush” and someone removed R1’s hygiene products from her room. S1 stated during interview that R1’s brush is kept in the bathroom, however, when LPA L. Holmes toured facility she observed the brush sitting on R1’s night stand along with personal hygiene products in R1’s room. Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the 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 violations occurred. Exit interview conducted and a copy of report was given.the state’s words, verbatim · CDSS document, Nov 1, 2024 · control 15-AS-20230728084348

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(3)(C) · Plan of correction due date: Nov 8, 2024

(a) Living accommodations... should be related to the facility's function... (3) ...supplies necessary for personal care and maintenance of adequate hygiene... the licensee shall assure provision of: (C) Clean linen... top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels... The quantity shall be sufficient to permit changing at least once per week... The linen shall be in good repair. This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having sufficient quantity of linen, which poses a potential health and safety risk for persons in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Licensee agreed to purchase linen and submit photos and receipts to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(4) · Plan of correction due date: Nov 15, 2024

(f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports Based on interviews and observation the Licensee did not comply with the section cited above in assisting resident with personal grooming, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Licensee agreed to keep a log or notes of bathing and grooming schedule and submit a 2-week copy to CCLD.

Allegation investigated: Facility did not seek medical attention for resident in a timely manner for a hip fracture Facility did not meet resident's medical needs Facility retaliated for filing a complaint Facility did not safeguard resident’s personal belongings Staff left resident with feces for extended periods of time Facility overcharged resident

On 11/1/2024 at 1:20pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver complaint findings for the allegations above. LPA met with Susana Cunanan, Caregiver. Licensee, Maria Riformo, arrived at 1:35pm and LPA and explained the reason for the visit. During the investigation the Department interviewed the reporting party (RP), staff, obtained and reviewed R1’s records. Allegation: Facility did not seek medical attention for resident in a timely manner for a hip fracture. Continued on LIC9099C. Unsubstantiated Continued from LIC9099. On 7/31/2023 R1’s family arrived at the facility to take R1 to a doctor’s appointment. The family took R1 away from the facility in their private vehicle. R1 was then admitted into Contra Costa Regional Medical Center with a complaint of neglect/abuse and dementia. The Department requested and reviewed medical records from Contra Costa Regional Medical Center dated 7/1/2023 to 10/06/2023. Record review indicated R1 was admitted to Contra Costa Regional Medical Center on 7/31/2023. Hospital staff conducted a medical work up which included an x-ray and CT head. The x-ray returned with no evidence of a fracture. Based on medical records and facility records there is not enough information to state the need for medical attention on that particular date. Allegation: Facility did not meet resident's medical needs During interview with RP it was stated that R1 had multiple bruises, malnourished, a vitamin deficiency, hip fracture, and had sustained a stroke while in care. Record review of Contra Costa Regional Medical Center records dated 7/31/2023 indicates R1 had bruising but not from abuse or neglect, no fracture, no stroke, no vitamin deficiency, or malnourishment. Record did state that a supplementation should be considered for R1. S1 stated R1 had been living at the facility for approximately 10 years and has slowly been declining and had to be reminded to eat. Allegation: Facility retaliated for filing a complaint During initial interview RP stated facility retaliated due to a previous complaint towards the facility. During S1’s interview she stated that R1’s family member Continued on LIC9099C. Continued from LIC9099C. arrived to take R1 to an appointment that had been canceled. S1 stated due to the family’s previous history at the facility she denied entrance because she did not feel safe not to retaliate, and the Contra Costa Sheriffs were called to help with the situation. Allegation: Facility did not safeguard resident’s personal belongings During initial interview RP stated R1’s belongings had mildew on it. RP submitted a photo that showed three (3) pair of shoes. Two (2) shoes had some unknown material on them but during review LPA could not distinguish if it was mildew, dust, or dirt. The photo was taken outside on the cement at unknown location. Allegation: Staff left resident with feces for extended periods of time RP stated when R1 was removed the facility and taken to the Contra Costa Medical Center R1’s diaper had not been changed and there was crusted feces in her diaper. RP submitted photos as documentation. LPA reviewed photos and observed a small amount of something brown in color on diaper and on the body of the person in the photograph. However, there isn’t enough evidence to suggest that staff left resident with feces for an extended period of time. Allegation: Facility overcharged resident RP stated during initial interview that R1 had been charged for appointments but had not been seen by the primary physician since October 2022. S1 stated the facility do not charge for doctor appointments. Review of the admission agreement under basic services item 7 indicates the family is responsible for transporting the resident to medical or dental appointments. Continued on LIC9099C. Continued from LIC9099C. Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the 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. Exit interview conducted and a copy of report was given.the state’s words, verbatim · CDSS document, Nov 1, 2024 · control 15-AS-20230901131403

Type of visit: Case Management - Other

On 11/1/2024 at 3:15pm, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct a Case Management visit. LPA met with Maria Riformo, Licensee. While LPA L. Hall was conducting a complaint investigation 15-AS-20230901131403 on 11/1/2024. LPA observed facility did not have a qualified and currently certified administrator. LPA also observed R1 did not have a chest of drawers for clothing in the bedroom. 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 the appeal rights and this report provided.the state’s words, verbatim · CDSS document, Nov 1, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(a) · Plan of correction due date: Nov 2, 2024

(a) All facilities shall have a qualified and currently certified administrator. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours... When the administrator is not in the facility, there shall be coverage by a designated substitute... This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having a qualified and certified administrator, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Licensee agreed to implement a plan to hire a new administrator and submit plan to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87307(a)(3)(B0 · Plan of correction due date: Nov 8, 2024

(a) Living accommodations... shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents... who may reside in the facility. (3) Equipment and supplies necessary for personal care... shall be readily available to each resident. ...the licensee shall assure provision of: (B) Bedroom furniture... a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers. This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having a chest of drawers for R1, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Licensee agreed to purchase a chest of drawers for R1 and submit a photo to CCLD by POC date.

Type of visit: Required - 1 Year

On 08/20/24 around 08:45 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required annual inspection. LPA was greeted by one staff upon entry and explained the purpose of the visit. Maria Riformo, Administrator (ADM) arrived about 10 minutes later. Co-Licensee currently holds a standard certificate (#6006016740). The facility’s fire clearance was approved for six (6), four (4) may be non-ambulatory residents. Upon entry, LPA observed one (1) resident sleeping and later going to the bathroom. LPA and ADM toured the facility including, but not limited to common areas, bathrooms, bedrooms, kitchen, and backyard. LPA observed mask, cough etiquette, social distancing and hand washing signs posted throughout. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All hand washing stations were equipped with soap, paper towels and garbage cans. Licensee to increase the surplus of PPE that is centrally stored in the facility and accessible to all care staff. Hot water temperature in the shared residents' bathroom was measured at 107.8 degrees Fahrenheit (F) and the facility's temperature was 69 degrees (F). Smoke/Carbon Monoxide detectors were observed operational and first aid kit complete. continued on LIC809C... ...continued from LIC809. Fire extinguisher was observed full and tagged with receipt on 07/05/24. Emergency Disaster Plan is updated. Last safety drill conducted 07/15/24 and is rotational between AM and PM schedules quarterly. LPA reviewed three (3) staff files with criminal record clearances, and four (4) resident files. After repairs are completed, licensee to remove 3-4 wooden boards, 2 shower glass doors, and a screen in disrepair at the sliding door of the dining room. The following forms are to be updated and submitted to CCLD 09/03/24: -Resident Roster -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility -LIC610E Emergency Disaster Plan (Reviewed) -An updated copy of Administrator Certificate(s) -Infection Control Plan (Reviewed -Removal of debris Exit interview conducted and a copy of this report provided to ADM.the state’s words, verbatim · CDSS document, Aug 20, 2024

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 4/12/2024 at 2:45pm, Licensing Program Analysts (LPAs) L. Hall and L. Holmes arrived unannounced to conduct a Case Management visit. Licensee, Maria Riformo, arrived at 2:55pm When LPAs arrived to facility to conduct a complaint investigation (15-AS-20230728084348) on 4/12/2024, LPAs observed two (2) people at the facility. LPAs was informed by the two (2) people that they were visitors and no staff was present. *An immediate civil penalty of $500.00 will be assessed on today's date for absence of supervision* Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. 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. A copy of this report, LIC421M, and appeal rights providedthe state’s words, verbatim · CDSS document, Apr 12, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Apr 13, 2024

(a) Facility personnel shall at all times be sufficient in numbers... to provide the services necessary to meet resident needs... The licensing agency may require any facility to provide additional staff whenever it determines... This requirement was not met as evidence by: Based on observation and interview the Licensee did not comply with the section cited above in having staff present at the facility, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 12, 2024

Plan of correction: Licensee arrived at 2:55pm, 10 minutes after LPAs arrived. Deficiency cleared during visit.