Hoen's Care Home

Type of visit: Office

A Non-Compliance Conference (NCC) was conducted today in the Santa Rosa Regional Office. Present in the meeting were: Acting Regional Manager (RM) Bethany Moellers, Licensing Program Manager (LPM) Victoria Bertozzi, Licensing Program Analysts (LPAs) Christi Coppo, Robert Frank and Licensees Lily Alcones and Arthur Alcones. The purpose of today's office meeting was to discuss areas of concern in the facility operation identified by the department and placing Sleepy Hollow Assisted Living, Hoen’s Care Home and Spring Creek Lodge on a Non-Compliance Conference (NCC) plan. Parties present during the meeting agreed to an NCC plan to bring the facilities into compliance. An Office meeting was held 9/15/2025 to discuss a change of ownership (CHOW) for all licensed facilities from a sole proprietorship to an LLC. An application for Spring Creek Lodge for a Change of Ownership was received on 10/15/2025, however, Licensee did not provide required payment or the incomplete documents that were requested in a letter sent by the Central Applications Bureau on 10/23/2025, so the Application was withdrawn. The department has not received a Change of Ownership application for Hoen’s Care Home or Sleepy Hollow Assisted Living to date. Parties present during the meeting agreed to an NCC plan for 2 years to bring the facility into compliance. Health and Safety Code 1569.686 Licensee notification of specified events; department initiation of compliance plan, noncompliance conference, or other appropriate action; penalties; exception was printed and given to licensee. The licensee understand that may not operate under their LLC as they are licensed under sole proprietorship There was a discussion about Technical Support Program (TSP) referral and Licensee agreed to be referred to the TSP program and referral will be submitted. Deficiencies are cited from the California Code of Regulations (CCR), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted with licensee and a copy of this report given.the state’s words, verbatim · CDSS document, Jul 22, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(2) · Plan of correction due date: Jul 24, 2026

Qualifications and Duties 87405(d)(2) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This regulation was not met as evidenced by Licensee/Administrators not engaging in the CHOW process as directed in the 9/15/2025 Office meeting.the state’s words, verbatim · CDSS document, Jul 22, 2026

Plan of correction: Licensee to provide letter self-certifying that they will provide monthly updates on status of submitted application by plan of correction due date. This will be due every 22nd of the month. Facility to review Administrator qualifications and duties regulation and provide a monthly update on status of submitted application.

Type of visit: Required - 1 Year

Licensing Program Manager (LPM) Victoria Bertozzi and Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Licensee Lily Alcones arrived later. Facility currently has four (4) residents in care none of which are currently on hospice. At approximately 9:15am LPA and LPM toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered and labeled with opened dates present. LPA observed kitchen cabinet under sink to contain sharp knives. Cabinet was unlocked. Caregiver immediately locked cabinet with chain and pad lock. LPA discussed with licensee adding a magnetic lock or something easily locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required bath mats and grab bars. Water temperature in sinks measured at 109.4 degrees F in the kitchen and 111.3 degrees F in the bathroom in the back and 106.5 degrees F in bathroom used by residents, all of which are within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 11/06/25. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drill was conducted on 12/18/25. Facility has a backup generator for use during a power outage. Continued on 809... Continued from 809... At approximately 9:45am LPA conducted a review of four (4) out of four (4) resident files. Resident (R1) needs a current physician's report (deficiency cited, see 809D). Staff (S1, S2, and S3) did not have the required hours of training completed, a total of 40 hours plus 10 additional hours of medication training is required but staff had 26 hours. Additionally, S1, S2, and S3 need a total of 12 hours of dementia training but had 6 on file. LPA and licensee discussed required training hours needed (deficiency cited, see 809D). At approximately 10:30am LPA and Licensee conducted a spot check of medication and medication records. LPA discussed with licensee ensuring all PRN medications are listed on the Centrally Stored Medication Log. LPA and Licensee discussed Infection Control Plan. LPA and Licensee discussed Emergency Disaster Plan. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Mar 12, 2026

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Office

An informal meeting was conducted today in the Santa Rosa Regional Office. Present at the meeting were Licensing Program Managers Bethany Moellers and Victoria Bertozzi (via Teams), Licensing Program Analysts Christi Coppo, Robert Frank, Marisol Cuadra (via Teams) and Licensee of the facility, Lily Alcones and Back up Administrator Arthur Alcones. The purpose of the office meeting was to address areas of concern and discuss the change of ownership for Hoen’s Care Home # 496801205 and Spring Creek Lodge # 496803282 in which Lily Alcones is the identified licensee. Also, their sister facility Sleepy Hollow Assisted Living #496803576, in which Arthur Alcones is the identified licensee. On 9/10/25, LPAs learned about a change from individual to limited liability corporation (LLC). The areas of concern are reporting requirements and Administrator responsibilities and duties. The current options discussed during this office meeting are the following: -Licensee was not sure if she wants to keep facilities under the LLC or remove them from the LLC. CCL advised that licensee let CCL know their choice by no later 9/29/25. If they choose to keep the facilities in the LLC then licensee will need to submit a change of ownership application with new corporation or LLC to the Centralized Application Bureau (CAB) for the three facilities by no later than 10/13/25. CAB contact information was provided. - The Licensee agrees to review reporting requirements regulation (87211) and they will conduct all staff training to address ongoing reporting requirement issues by no later than 9/22/25. - Licensee stated that they do not plan to leave the country within the next 6 months and agreed to appoint a certified Administrator should they plan to be out of the country for an extended period of time. Extended Continued on 809... Continued from 809... period of time is defined as anything longer than 30 days. CCL provided copy of regulation 87407 and 87405, for both Hoen’s Care Home # 496801205 and Spring Creek Lodge # 496803282. -LPAs offered TSP services to licensee. Licensee refused participation. -LPA Coppo amended case management report dated 7/29/25 to correct language regarding death reports. LPA had licensee sign amended report and copy was given. Deficiencies are cited from the California Code of Regulations (CCRs), Title 22, Division 6, Chapter 8 and the Health and Safety Code. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Appeal Rights Given. Exit interview conducted with Licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Sep 15, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87109(b) · Plan of correction due date: Sep 29, 2025

87109 Transferability of License (b)The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing as soon as possible and in all cases at least thirty (30) days prior to the transfer of the property or business... This requirement is not met as evidenced by:Based on interview & record review, the licensee did not comply with the section cited above in the licensee did not notify Community Care Licensing within thirty (30) business days of the transfer of the facility to a Limited Liability Corporation which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 15, 2025

Plan of correction: Licensee to notify CCL regarding their choice to either remove facilities form LLC or keep them in the LLC by no later than plan of correction due date 9/29/25. If they choose to keep in the LLC, licensee will provide proof to Community Care Licensing that an application has been submitted to the Centrailized Application Bureau by plan of correction due date of 10/13/2025.

Allegation investigated: Licensee did not provide a refund upon resident's death

Licensing Program Analyst (LPA) Christi Coppo arrived at this facility unannounced, to deliver findings for the above allegation. LPA spoke to Arthur Alcones, Administrator. Complaint alleges licensee did not provide a refund upon resident's (R1) death. Complainant states that licensee collected $7000 too much from R1 for the month of April’s rent. During investigation, LPA reviewed evidence showing on 3/27/25 check #6807 cleared the account in the amount of $7000. On 3/28/25 there was a reversal for check#6807 and $7000 was added back to R1’s account. On 4/14/25 check #6808 in the amount of $14,000 cleared the account. Check #6808 in the amount of $14,000 covered rent for the months of April 2025 and May 2025. It is alleged that check #6807 was presented again for payment and cleared R1’s account. However, during investigation, LPA was not provided with Continued on 9009C... Unsubstantiated Continued from 9099... copy of R1’s bank statement for the month of May 2025. So, LPA cannot verify if check #6807 cleared R1’s account. During investigation, LPA received conflicting stories as to when rent for R1 was due. LPA was advised that rent for R1 was due the 18th of every month. LPA reviewed R1’s admission agreement. Admission agreement has move in date as 3/18/25. However, Admission agreement states that rent was due for move-in on 3/14/25, 4 days earlier than the actual move-in date, and after that, it was due the first of every month. Admission agreement states preadmission fees are not currently charged. During investigation, LPA was advised that R1 went to the hospital on 5/3/25. However, LPA received conflicting information from licensee. Licensee submitted a LIC 624 indicating that R1 went to the hospital on 5/16/25 and passed on 5/30/25. However, LPA received evidence showing that licensee informed I1 that R1 was sent to the hospital on 5/3/25 and LPA received copy of official Death Certificate indicating R1 had actually passed on 5/25/25. LPA received evidence that on 5/30/25 licensee contacted I1 via text advising I1 to speak to licensee’s attorney if I1 has any questions. Allegedly, licensee was responding to a phone conversation between I1 and licensee where I1 asked for a refund of monies due, since R1 had passed on 5/25/25 but had paid rent through 6/18/25. CCL received complaint on 6/12/25. Licensee submitted a copy of a check allegedly written on 6/5/25 in the amount of $3500 issued to R1 as a partial refund for the month of May 2025 rent. However, licensee could not provide LPA with proof that refund $3500 was ever cashed, cleared their account, or that R1 ever received the refund check. Additionally, licensee claims that R1’s items were not removed from facility until May 30, 2025. However, licensee could not provide LPA with any proof of the alleged date on which they were removed. During investigation, LPA received conflicting information. LPA was advised that R1’s things were packed up and put in a box without any of R1’s family or friends knowing. On May 18, 2025, R1’s items were picked up and removed from the facility by I1, upon arrival, I1 was handed a box of R1’s items, the box was retrieved from a closet in the facility. Per I1, caregiver at facility said that these were all of R1’s items and that I1 was not Continued on 9099C(2)... Continued from 9099C... allowed to go into R1’s old room, that I1 was to trust that all R1’s items were there. So, LPA received conflicting accounts of: when R1’s rent was due, when R1 went to the hospital, if R1 was issued a partial rent refund for the month of May 2025, and the date on which R1’s belongings were removed from the facility. So, 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, therefore the allegation is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Jul 29, 2025 · control 21-AS-20250612104410

Type of visit: Case Management - Deficiencies

**amended**Licensing Program Analyst (LPA) Christi Coppo arrived at this facility unannounced to conduct a Case Management. LPA spoke to Arthur Alcones, Administrator. Related to complaint 21-AS-20250612104410, LPA found the facility to be deficient in timely reporting. LPA received evidence that licensee was aware that R1 was hospitalized on 5/3/25 but did not submit an incident report to CCL as required per regulation 87211 (deficiency cited, see 809D) On 7/28/25, LPA reviewed all incident reports submitted by this facility beginning with the year 2021. LPA found that only one incident report has been submitted, on 7/11/2022. Considering the facility has a capacity of six residents, it seems unlikely that there was never another occurrence of any incident which threatened the welfare, safety or health of any residents, including but not limited to residents falling or needing medical attention. The appearance of a lack of reporting by this facility is concerning to LPA. Furthermore, the facility has submitted ten [10] Death Reports for the years 2021-present day 2025. Each of the 10 reports indicate the cause of death as cardiac arrest, including the report for R1, subject of complaint 21-AS-20250612104410. However R1’s cause of death was listed as septic shock and renal failure per R1’s official Death Certificate. LPA discussed lack of incident reporting with Administrator and their responsibility to ensure accurate reporting when submitting the cause of death for residents. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Jul 29, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a) · Plan of correction due date: Aug 5, 2025

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (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 of any of the events specified in (A) through (D) below…(A) Death of any resident from any cause regardless of where the death occurred…(B) Any serious injury…(C) The use of an Automated External Defibrillator. (D) Any incident which threatens the welfare, safety or health of any resident…This requirement was not met by licensee as evidenced by: Based on LPA record review licensee failed to submit an incident report for R1’s hospitalization, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 29, 2025

Plan of correction: Facility to submit LIC9098 self-certifying they will submit an incident report to licensening within 7 days for any occurances outlined in regulation by plan of correction due date.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Deniz and Cuadra arrived unannounced to conduct a required Annual inspection and was greeted by Caregiver. Licensee Arthur Alcones arrived later. Facility currently has resident on hospice which is allowable per the facility's Hospice Waiver. LPAs/ Licensee initiated a tour of the facility around 11:45 AM and made the following observations: Facility was a comfortable temperature, and passageways were free from obstructions. LPAs/Licensee observed fences next to the shaded area in the backyard needs to be repaired. Licensee agrees to repairs the damaged fences. LPAs observed emergency exit pathway concrete floor had cracks about 2 inches wide which poses a tripping hazard (Deficiency Citation Issued). Common area bathroom sink’s hose and hot water pressure need to be fixed. Licensee immediately called repair staff and they arrived at the facility for repair while LPAs were in the facility (Deficiency Citation Issued). Resident rooms were furnished per regulation. Water temperature in sinks accessible to clients measured at 118 degrees F and 114.2 degrees F which is within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cabinets containing cleaning supplies were locked. Facility has at least two days of perishable and one week of non-perishable foods which were of quality and stored per regulation. Medications were centrally stored and locked. Emergency food and water is stored in the storage room per Title 22 regulations. LPAs observed garbage bin was stored next to the clean utensils in the kitchen cabinet located under the kitchen sink. Licensee immediately removed the garbage bin into different space and put new one (technical violation issued). Continue on LIC809C... Continue from LIC809... Fire extinguishers were last serviced February 13, 2025. Facility smoke detectors located throughout the facility were tested and operational during inspection. But carbon monoxide detector wasn’t functional, and Licensee replaced it (Technical violation issued). Most recent fire/disaster drill was conducted 02/13/2025. LPAs initiated file review at 1:00pm. Four staff files and four resident files were reviewed. Staff have required First Aid and CPR certificates. Medications and medication records were reviewed. Administrator Certificate for Administrator, Lily Alcones # 7003673740 expires 03/10/2026. LPA is requesting the following documents to be submitted to Community Care Licensing by 03/26/2025: LIC 500 Personnel Report LIC 308 Designation of facility responsibility Updated Liability Insurance Emergency Disaster Plan (Review and update if need it) Control of property. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Licensee. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted. Copy of report discussed and provided to Licensee.the state’s words, verbatim · CDSS document, Feb 27, 2025

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff did not ensure that the facility was free of pests.

At approximately 2:00PM, Licensing Program Analyst (LPA) Christi Coppo and Licensing Program Manager (LPM) Victoria Bertozzi arrived at this facility unannounced, to open an investigation into the above allegation. Complaint alleges facility not free of pests. Based on LPA and LPM observation rodent droppings present in food pantry and in kitchen drawer to the right hand side of the range/oven. Also, waterline from dishwasher to under the sink is leaking and plastic bag appeared to be chewed on. Per Title 22 regulaiton 87555 General Food Service Requirements (b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. Based on LPA's observations, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D. Substantiatedthe state’s words, verbatim · CDSS document, Apr 26, 2024 · control 21-AS-20240417171429

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(27) · Plan of correction due date: May 6, 2024

87555 General Food Service Requirements (b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement was not met by licensee as evidenced by: Based on LPA and LPM observed rodent droppings present in food pantry and in kitchen drawer to the right hand side of the range/oven, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 26, 2024

Plan of correction: Facility to submit LIC9098, service order from pest control company, and pictures of cleaned up drawer and pantry where dropping where observed by plan of correction due date.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to amend facility evaluation report, deficiency page and remove civil penalty issued on 3/22/2024.LPA was greeted by facility designee, Hazelyn Azucena. Administrator Arthur Alcones was contacted via telephone but was not available. LPA left voicemail, to be advised of LPA visit and purpose of visit. Exit interview conducted with facility designee, a copy of this report and the amended deficiency page was given.the state’s words, verbatim · CDSS document, Apr 4, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced and was greeted by facility designee, Hazelyn Azucena. LPA arrived at facility to amend deficiency page issued during POC visit on 3/22/2024. LPA amended deficiency page to include plan of correction. Administrator Arthur Alcones was contacted via telephone to be advised of LPA visit and purpose of visit. Exit interview conducted with facility designee, a copy of this report and the amended deficiency page was given.the state’s words, verbatim · CDSS document, Apr 3, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Caregiver. Administrator Arthur Alcones arrived later. Facility currently has one resident on hospice which is allowable per the facility's Hospice Waiver. At approximately 9:30am LPA and Administrator toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered and labeled. Kitchen cabinet containing cleaning supplies and sharp knives was locked. Per LPA observation and record review, all bedrooms were equipped with lighting, night stand, and chest of drawers. All bathrooms did not have non-skid bath mats, bathroom in room #5 had a mat but the non-skid did not work and would slide with ease once stepped on(deficiency cited, see 809D). Water temperature in sink(s) accessible to residents in care measured at 118 degrees F which is within the allowable range of 105 to 120 degrees F. LPA and Admin observed bathroom in room #5 did not have grab bars. Per Title 22 regulation 87303(a)(4) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. (4) Grab bars shall be maintained for each toilet; bathtub and shower used by residents (deficiency cited, see 809D). In bathroom #3 the bottom of the sink is cracking and peeling off, a white bath mat was found to have a brown film and was not non-skid. Bathroom in room #1 smelled of urine and brownish yellow pool film of a substance was located on back side of toilet, sticky and yellow film in front of toilet, and spatters of a dark substance on the wall. Also, bathroom in room #5 and room in general had strong smell of urine. Continued on 809C... Continued from 809... Per Title 22 regulation 87303(a)(1) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition (deficiency cited, see 809D). Per LPA observation and record review, main hallway bathroom had smears of a dark brown substance in multiple places on the wall and by the toilet paper roll. LPA and Admin also observed darkened wet pieces of wood under peeling wallpaper present on frame at the bottom of the shower. Sink in main bathroom also needs repair as layers upon layers of caulking harboring a brown and orange-yellow substance. LPA and Admin observed bedroom window sills in rooms not free of dirt and debris. LPA and Admin observed front door knob not to work, the door does not latch shut. LPA and Admin observed electrical wall faceplate broken, leaving outlet exposed. Per Title 22 regulation 87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors (deficiency cited, see 809D). At approximately 12:00pm LPA conducted a review of 6 out of 6 resident records. Half rail orders were not on file for R2, R4, and R5. Per Title 22 regulation 87608(a)(5)(A) Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet.(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed(deficiency cited, 809D). Continued on 809C(2)... Continued from 809C... Fire extinguishers were last inspected 9/15/2023. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Exit doors have an auditory alert system that was functional at time of inspection. Facility’s last quarterly disaster drill was conducted on 2/4/2024. Facility has a backup generator for use during a power outage. Per LPA and Admin observation and record review, residents R4, R5 did not have an admission agreement and R2's admission agreement was not dated by either party. Per Title 22 regulation 87507(a) Admission Agreements (a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any (deficiency cited, see 809D). Per LPA and Admiobservation and record review, residents R2 and R3 did not have a current Physician's Report, most current for both dated 2022. Per Title 22 regulation 87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs (deficiency cited, see 809D). At approximately 3:00pm LPA reviewed staff files. S1 did not have Health Screen/TB clearance, CPR/1st aid or complete requirements for training. S1 has been employed since October 2023 so 40 hours is required, only 6 completed. Per Health and Safety Code 1569.625 Staff training; legislative findings; contents (b) (1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training (deficiency cited, see 809D). A Health Screen for S1 not available. Per LPA interview with S1, they never completed a Helath Screen. Per Title 22 regulation 87412(a)(11) Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411(deficiency cited, see 809D). Continued on 809C(3)... Continued from 809C(2)... Lily Alcones Administrator Certificate 6013178740 expires 3/9/2024; however, certificate is currently in Renewal-Pending status. All fees are current as of this time. At approximately 3:50pm LPA and caregiver conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Evidence of Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Licensee. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Feb 14, 2024