Huntington Eldercare IV

Allegation investigated: Staff caused injuries to a resident while in care Resident is left unattended for extended period of time Resident incontinence needs are not being met while in care Staff speaks inappropriately towards a resident Residents are being mistreated while in care

Licensing Program Analyst (LPA) Jenifer Tirre delivered the complaint investigation findings by telephone due to facility’s closure on December 10, 2025. LPA Tirre discussed the complaint findings with Licensee Carmen Achim. During the course of investigation, the Department interviewed staff, made observations and reviewed records. Department received Resident Roster, Appraisal Needs and Service Plan and Physician’s Report. The investigation conducted revealed the following: On November 19, 2021, the department received a complaint alleging that staff caused injuries to a resident while in care, resident is left unattended for extended period of time, resident incontinence needs are not being met while in care, staff speaks inappropriately towards a resident, and residents are being mistreated in care. Interviews were conducted with facility staff, visual observations were made, records were reviewed. The following were mentioned and noted per allegations: CONTINUED ON 9099C Unsubstantiated Regarding allegation Staff caused injuries to a resident while in care, It was alleged that Resident 1 (R1) sustained bruises due to improper handling of Staff 1 (S1). Per interviews conducted with staff members, two of three staff stated that they helped assist R1 when they asked for help. Three of three staff interviewed stated that Staff 1 primarily handled R1 and that R1 was “full assist”. Three of three staff members stated that they never noticed bruising on R1’s body. Per interview with S1, states they never handled R1 in a rough manner and that R1 was very alert. Three of three staff stated that they never witnessed other staff mishandling R1 while in care. During initial visit conducted on November 24, 2021, LPA toured facility physical plant and observed residents relaxing inside bedrooms watching television. LPA observed R1 inside bedroom on recliner chair and did not observe any visible bruising on R1’s body. LPA was unable to interview R1 due to R1 resting on recliner at time of visit. LPA attempted to interview other residents but due to their medical condition’s interviews were not successful. The LPA attempted to identify and contact R1’s family members for interviews, however, no information was available during record review. Per Record Review, LPA Tirre did not observe any incident reports related to alleged injury for R1. Regarding Allegations Resident is left unattended for extended period of time and Resident incontinence needs are not being met while in care. It was alleged that R1 was left alone for long periods of time that they often had incontinent accidents due to not being taken to the bathroom. Investigation revealed the following: Per staff interviews, Three of three staff stated R1 was never left unattended due to facility always had staff present inside the facility. Three of Three staff stated that R1 needed full assistance with areas of daily living including toileting and staff stated they were available to help R1 whenever needed. One of three staff interviewed stated that resident wore pull up underwear and was not left soiled for periods of time. One of three staff stated they could not recall if R1 had incontinence issues. During visits to facility, LPA observed two staff members on duty who were attentive to residents’ needs. One staff member was checking on residents in bedrooms while another staff member was supervising other residents in common area. The LPA attempted to identify and contact R1’s family members for interviews, however, no information was available during record review. During Department visits, Department reviewed Resident records and observed that R1’s Physician’s report dated May 3, 2021, stated that R1 had diagnosis of Spinocerebellar ataxia stating R1 was wheelchair bound and fall risk. Physician’s Report also stated that R1 does not require continuous bed care and is able to communicate their needs. CONTINUED ON 9099C A record review of R1’s Appraisal/ Needs Service Plan dated August 12, 2021, stated under R1’s physical health. R1 is wheelchair bound and needs 100% assistance. Record review did not mention R1 having incontinent issues during time at facility. Regarding Allegation Staff speak inappropriately towards resident, it was alleged that staff were verbally abusive to R1, the investigation revealed the following: Staff interviews were conducted with three staff. Staff 1 stated that they never yelled or spoke inappropriately to R1. Staff 1 mentioned that R1 could be mean towards staff due to language barrier and stated that R1 would often tell staff “Oh you don’t understand me, this will be your last day, you are fired”. Staff 2 stated they never yelled at R1 or used profanity. Staff 3 stated that they never spoke inappropriately towards R1 and did not witness staff verbally abusing R1. Staff 3 stated that R1 was not pleased with any of staff at facility and often had an attitude and would belittle other staff for having foreign accent. LPA attempted to interview other residents but due to their medical condition’s interviews were not successful. The LPA attempted to identify and contact R1’s family members for interviews, however, no information was available during record review. During visits to facility, LPA did not observe any staff speaking in an inappropriate manner to residents. LPA observed staff being courteous of residents asking residents politely about their needs. Regarding Allegation residents are being mistreated while in care, it was alleged that residents were improperly mishandled, and the investigation revealed the following. Three of three staff were interviewed and three of three staff stated that R1 was not mistreated. Staff interviews stated that R1 was full assist and staff would often have to transfer R1 from chair to bed or chair to toilet. Staff 1 stated that they were never rough in handling residents and stated that R1 was very alert and often expressed if they did not like the way things were done. Three of three staff stated that staff tended to resident when needed assistance and if Resident requested for something. LPA observed R1 inside bedroom recliner resting and LPA was unable to interview at initial time of visit. LPA attempted to interview other residents but due to their medical conditions, interviews were not successful. The LPA attempted to identify and contact R1’s family members for interviews, however, no information was available during record review. During visits, LPA did not observe any staff mistreating residents physically or verbally. LPA observed S1 move a resident from bed to wheelchair and did not observe S1 mishandle resident or resident complain about the way they were handled. Per record review, LPA did not observe an incident reports related to residents being mistreated. CONTINUED ON 9099C Based on information provided, there is lack of supportive information between allegations reported, interviews, observations and records reviewed deeming all allegations: Staff caused injuries to a resident while in care, Resident is left unattended for extended period of time, Resident incontinence needs are not being met while in care, Staff speaks inappropriately towards a resident & Residents are being mistreated while in care to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred as reported. Facility closed and had a change of ownership effective December 10, 2025. An exit interview was conducted via telephone with Licensee Carmen Achim and a copy of this report was discussed and mailed out to last provided address for Licensee.the state’s words, verbatim · CDSS document, Jan 22, 2026 · control 22-AS-20211119160554

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 (S1) at 8:15am. LPA met with Administrator, Carmen Achim and explained the purpose of the visit. LPA was informed that the facility is currently going through a Change of Ownership (CHOW). The facility is a seven bedroom, single story residence with an approved fire clearance of six non-ambulatory residents and an approved hospice waiver for three.. The facility currently has a census of six residents in care. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in six of six resident bathrooms, and testing auditory devices on all exits, The hot water temperature measured between 113.7 and 116.6 degrees Fahrenheit and all smoke detectors were operational. The fire extinguisher is charged and was serviced on March 7, 2025. The facility’s last fire drill was conducted on September 30, 2025. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. More than fifteen gallons of water was observed in the garage with the emergency food supply. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. A PRN/ As Needed log is available but has not been used due to residents not requiring as needed medications A First Aid Kit was observed with all of the required elements. LPA toured the exterior of the property and observed a shaded seating area and all exterior exit gates were self-latching. There are no hazards or obstructions in outdoor pathways and there is plenty of space for activities. LPA also observed the PUB 475 and Long Term Care Ombudsman posters posted. (Continued on LIC 809-C) (Continued from LIC 809) LPA toured resident bedrooms and noted all had the required furnishings and clean linens. All resident bathrooms had grab bars and there were no chemicals under any resident sinks. Postural support orders were on file. LPA reviewed two of two staff training and fingerprint records and conducted a review of three of resident records. Updated Admissions Agreements were on file. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on December 1, 2027. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Carmen Achim, Administrator and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.the state’s words, verbatim · CDSS document, Dec 8, 2025

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 3 residents and the home currently has 5 residents, with 3 residents on hospice. Administrator (AD) Carmen Achim arrived shortly after. AD has a valid certificate that expires on 12/1/2025. AD provided updated liability insurance that expires on 5/30/2025. LPA along with staff 2 (S2) toured the facility at 1:30 PM. LPA toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 6 resident bedrooms, living room, dining room, staff room, and kitchen as well as 8 bathrooms. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. At 1:36pm, LPA observed 2 large bottles of opened alcohol in the kitchen refrigerator. At 1:40pm, LPA observed 1 out of 4 electric stove burners non-operational. At 1:46pm, LPA observed scissors in an unlocked right drawer of the sink in the bathroom nearest to the living room. At 1:52pm, LPA observed clorox cleaner in an unlocked cabinet under the sink in the bathroom of bedroom 5. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 107.7 degrees F and 110.8 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans. Outside grounds were toured. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise and pet therapy. There is shaded outdoor seating for residents. Exit gates are unlocked and operational. LPA observed the emergency food supply. LPA reviewed five resident files and two staff files. All resident files contained required documentation including physician reports, and resident appraisals. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPA reviewed medication storage and administration. Medications are stored in a locked closet. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.the state’s words, verbatim · CDSS document, Mar 27, 2025

The state marks this report as 9 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.