In Honor of Our Parents

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with caregiver Albertina Williams and explained reason for visit. Administrator Angela Love arrived shortly. The facility is licensed to serve (6) elderly adults ages 60 and above, of which (6) can be non-ambulatory and (1) Bedridden in room #5. The facility has an approved hospice waiver for (1). Facility shall have awake staff 24/7. The facility is a single-story home located in a residential neighborhood. It consists of the following: five (5) resident rooms, two (2) bathrooms, living room, dining room, den, and kitchen, room in the attic upstairs for staff, and outside patio area with detached garage. All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, and lighting. Room #1 had a broken fire detector with wires exposed. LPA observed two bedrooms that had cameras and one of the residents’ bedrooms were being observed in living room. R5 had full bed rails with no physician order. Smoke detectors/carbon monoxide detectors were observed in rooms and throughout facility. The facility has two (2) fire extinguisher that are fully charged in kitchen and hall. LPA observed unlocked cabinet in laundry area with chemicals accessible to residents. Cleaning supplies, sharp objects, and toxic substances are locked in office. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 45 degrees F. LPA observed a sufficient supply of 2-day perishable and a sufficient supply of 7 days non-perishable foods in the kitchen. There are no firearms or weapons stored at the facility The resident bathrooms have the required grabs, bars and non-skid mats. The hot water temperature in the bathrooms were not measured between the required range of 105-120 degrees F. B1 had a reading of 140.9 and B2 128.4. The common areas, including the living room and dining area, have the required furniture. Boxes of diapers and other items need to be removed from living room. The facility does not have a swimming pool or large body of water. There is a shaded seating area for the residents in back yard. LPA observed a clear plastic bin with cleaning items accessible to residents on the floor along with other items that need to be removed. Two staff files were reviewed and included Criminal clearance record, health screening with TB, and CPR/First Aid certificates. Administrator and two (2) staff did not have files at facility. Five (5) resident files were reviewed and were missing updated physicians reports and needs and service plans LIC 625. One residents file was missing. There were no drills conducted. Required liability insurance was expired. Three (3) resident medications were reviewed, and discrepancies were found. Medications are centrally stored in kitchen. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC 809D. Exit interview was held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 28, 2026

The state marks this report as 10 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Allegation investigated: Staff accepted a resident with a prohibited health condition.

On October 22, 2025, at 12:25 p.m., Licensing Program Analyst (LPA) Pamela Bunker conducted an initial visit to gather information regarding the above allegation. LPA met with Licensee Angela Love and explained the purpose of the visit. LPA was granted entry into the facility. The investigation consisted of the following: On 10/22/2025, the following documents were reviewed and obtained as part of the investigation: Personnel Report (dated 09/16/2025), Resident Roster (dated 10/21/2025), Admission Agreement (dated 06/13/2025), Identification and Emergency Information (dated 06/13/2025), Physician’s Report (dated 06/13/2025), Medical Assessment (dated 0613/2025), Medication Administration Records (MARs) (06/13/2025 - present), Appraisal & Needs and Services Plan (dated 06/13/2025), Resident Appraisal Residential Care Facilities for the Elderly (06/13/2025), Functional Capability Assessment (dated 06/13/2025), Preplacement Appraisal Information (dated 06/13/2025), House Rules (dated 06/13/2025), Personal Rights (dated 06/13/2025), Consent Forms (dated 06/13/2025), See continued LIC9099-C – Page 2. Unsubstantiated Continued LIC9099-C – Page 2 Hospice enrollment packet (dated 06/13/2025), and Advance Health Care Directive (dated 08/11/2025). On 09/16/2025 and 10/22/2025, LPA Bunker toured the facility's buildings and grounds to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. No signs of neglect or abuse were observed during today's visit. On 10/22/2025, between 1:00 p.m. and 4:30 p.m., LPA Pamela Bunker conducted interviews with staff members #1–#4 (S1–S4) regarding the complaint allegation. On 10/22/2025, from 12:30 p.m. to 1:00 p.m., LPA Bunker attempted to interview residents #1–#3 (R1–R3). R1-R2 are non-verbal and unable to participate in the interview process, and R3 failed to answer any of the questions posed, follow the conversation, or demonstrate understanding of the inquiries. Investigation revealed the following. Allegation: Staff accepted a resident with a prohibited health condition. On 10/22/2025, between 1:00 p.m. and 4:30 p.m., the Department conducted interviews with staff members #1-#4 (S1-S4). Who stated that the facility did not accept a resident with a prohibited health condition. 4 out of 4 staff confirmed that Resident #1 (R1) was admitted to the facility with a stage lV wound and is currently on hospice care, receiving ongoing treatment for the condition. 4 out of 4 staff stated that the hospice team provides regular services to R1. A home health nurse visits once a week, a bath nurse visits twice a week, and the wound care physician visits once a week. 4 out of 4 staff reported that R1 no longer has a gastrostomy tube. The Stage IV wound is actively being treated by R1’s wound care physician using stem cell therapy. 4 out of 4 staff members confirmed that the facility holds an approved hospice waiver, authorizing the provision of hospice services within the facility. 4 out of 4 staff members denied the allegation. On 10/22/2025, from 12:30 p.m. to 1:00 p.m.., the Department attempt to interviewed three residents #1-#2 (R1-R2). 2 out of 2 residents was non-verbal, and 1 out of 3 had difficulties understanding and answering the questions. See continued LIC9099-C – Page 2 Continued LIC9099-C Page 3. The Department reviewed Resident #1’s (R1) Physician’s Report and Hospice Records dated June 13, 2025, through the present. R1 was admitted to the facility on June 13, 2025, in accordance with the signed Admission Agreement. The Physician’s Report, completed on the date of admission, documented that R1 presented with a Stage IV wound upon entry. Hospice records, also dated June 13, 2025, confirm that R1 was under the care of Appling Hospice at the time of admission and has been receiving wound treatments and in-home health services since that time. Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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 deemed unsubstantiated. There were no deficiencies cited. A copy of the Complaint Investigation Report LIC9099 and LIC9099-Cs was provided to Angela Love, Licensee. An exit interview was conductedthe state’s words, verbatim · CDSS document, Oct 22, 2025 · control 11-AS-20250910171345

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced Required - 1 Year Annual visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the evaluation, the facility is clear of COVID-19 infection. LPA was properly screened for COVID-19 symptoms, and temperature was checked. LPA Bunker met with Licensee/Administrator Angela Love and explained the purpose of today's annual inspection. LPA verified that the facility has an approved Mitigation Plan Report and Infection Control Report. There are currently six (6) residents in placement. The facility's annual fees are up to date. The following 12 Domains will be observed and reviewed: Infection Control, Operational Requirements, Physical Plant & Environmental Safety, Staffing, Personnel Records-Training/Staff Training, Resident Rights-Information, Planned Activities, Food Service, Incidental Medical and Dental, Resident Records/Incident Reports, Disaster Preparedness, and Resident with Special Health Needs. "LPA Bunker will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services' facility inspections." Ms. Love and LPA Bunker toured the facility, which is a single-story family home located in a residential neighborhood. The house consists of a living room, family room, dining room, kitchen, office, 5 bedrooms, 2 bathrooms, laundry room, detached garage, an indoor/outdoor activity area, and a shaded area furnished with outdoor patio furniture, including tables and chairs. Bedrooms #1 through #5 are designated as the resident's bedrooms. See continued LIC809-C page 2 Continued LIC 809-C page #2 LPA Bunker observed the facility’s infection control practices, including screening protocols for residents and visitors, hand sanitizer, a visitor log, and a thermometer in the facility's living room. Logs documenting daily COVID-19 screening and temperature checks of clients and staff were available and up to date. PPE supplies are readily available to staff, and an additional supply of Personal Protective Equipment (PPE) was observed. Sufficient quantities of liquid soap, paper goods, cleaning, and disinfecting supplies were observed. Documents are posted as mandated on the wall in the living room, family room, and the hallway. The following Title 22-regulated areas were audited and found to be in compliance: The facility telephones are working. Bedrooms: All bedrooms meet the required standards for furniture, safety, privacy, and comfort. The facility has an adequate linen supply. Bathrooms: The bathrooms are clean and operational, and provide necessary personal accommodations with non-slip surface mats ensuring safety and privacy. Kitchen and Food Service: The kitchen is adequately equipped for food preparation and service. A review of the food service revealed an ample supply of perishable and nonperishable food, stored appropriately. Medication Storage and Management: Medications are centrally stored in a locked cabinet in the office with up-to-date records, ensuring proper storage and documentation. Common Areas: The Living room, dining room, and common areas are well-maintained, free of potential hazards, and meet the cleanliness standards necessary for the safety and well-being of residents. Safety Equipment and Measures: The facility is equipped with a fully stocked first aid kit with manual, functional smoke and carbon monoxide detectors, and a properly charged fire extinguisher. The hot water temperature is measured at 105 and 108.5 degrees and is maintained within the standard range of 105-120 degrees Fahrenheit. Emergency Preparedness: All exit doors are in compliance, the client's bedroom windows are equipped with sliding window locks without thumbscrews, and the facility conducted a fire drill on May 15, 2025. Environmental Safety: The yard is free from debris and hazards, trash cans are covered, and no firearms or bodies of water are present on the premises. Hazardous items are kept inaccessible to clients. Staff Training: Staff members have received training on dependent adult and elder abuse reporting. Administrative Compliance: The Administrator's Certificate is current, with an expiration date of August 26, 2025. Compliance with HIV/TB requirements is also verified. LPA Bunker provided Licensee/Administrator Angela Love with a copy of the facility evaluation reports. There were no deficiencies cited. An exit interview was conducted.the state’s words, verbatim · CDSS document, Jul 31, 2025

Allegation investigated: Staff did not meet the residents incontinence needs. Staff did not seek timely medical attention for a resident. Staff did not have planned activities for the residents.

On May 15, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent visit to gather information regarding the above allegations. LPA met with the administrator, Angela Love, and explained the purpose of the visit. LPAs were granted entry to the facility. The investigation consisted of the following: An initial complaint visit was completed by the Department on 05/20/24 to obtain facility files. The Department conducted a subsequent visit on 05/15/25 and 05/16/25. The Department investigated the allegations mentioned in this complaint and conducted interviews with staff (S1-S4), residents (R1-R5), and witnesses (W1-W3). The following records: Resident Roster, Staff Roster, Resident Appraisals (dated 09/13/1, 03/04/08, 12/08/23), IID/Emergency Information (dated 11/16/23, 12/08/23), Physicians Reports (dated 09/12/22, 08/09/24, 09/12/22, 08/24/23, 01/26/24), and other records pertinent to this complaint. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #2: Staff did not meet the residents' incontinence needs. It is alleged that facility staff did not meet residents’ incontinence needs. It was reported that residents were left soiled during the evening hours and did not get their diapers changed, and developed pressure injuries. No further details have been provided concerning this allegation. On May 15, 2025, between 10:00 AM and 2:00 PM, the Department interviewed resident members identified as Resident #1 through Resident #5 (R1-R5). Three (3) out of the five (5) could not validate this allegation. (R1, R3, and R4) stated having no concerns or issues with incontinence care. (R4) praised the staff, highlighting their responsiveness and willingness to assist. (R2 and R5) were interviewed, but their health conditions affected their communication ability. They could not carry out full conversations. On May 15, 2025, between 10:00 AM and 2:00 PM, the Department interviewed staff members identified as Staff #1 through Staff #4 (S1-S4). Four (4) out of the four (4) staff members could not support this allegation. (S1) stated that they had not heard any dissatisfied residents or family members complaining about incontinence care. (S1) explained that diaper care for residents is based on each resident's care plan. (S1-S4) explained that residents requiring incontinence assistance are served four times daily or as needed and that no residents are left in soiled diapers. Staff members (S1-S4) reported that no care residents have ever developed bedsores. (S1) stated that residents in care have static air mattresses that prevent pressure sores due to limited mobility. Residents are repositioned every two hours to prevent pressure injuries, and staff received training from hospice and home health on how to avoid these injuries. On May 13, 2025, and May 15, 2025, between 10:40 AM and 2:00 PM, the Department interviewed witness members identified as Witness #1 through Witness #3 (W1-W3). Three (3) out of the three (3) witness members could not verify the allegation. (W1) the Program Director at Morningside Adult Day Health, described (R2, R3, and R5) as well groomed, cared for by staff, and has never appeared in soiled clothing or diapers at the day program. (W2 and W3) Home health services representatives verified that (R1) was receiving home health services, the aides staff provided incontinence care, and there were no indications from home health aides that (R1) had incontinence problems. (Evaluation Report continues LIC 9099-C) The Department reviewed (R1-R5)’s Physician Report LIC 602A (dated 09/12/22, 01/24/23, 01/26/24 and 08/09/24) and Resident Appraisal LIC603 (dated 03/04/08, 09/13/11, 01/24/23, and 12/08/23) confirmed (R1-R2 and R4-R5) required assistance with incontinence services (R3) is independent. (R1)’s Home Health Charting Notes (dated 07/01/24 through 09/01/24) verified no documentation of the resident’s issues with incontinence care. A review of staff training shows that personnel have completed essential caregiving courses. Further examination of the facility’s Personnel Report LIC 500 confirmed that care staff are available for all shifts, including the night shift. Based on the information gathered, there is not enough evidence to support the allegation mentioned above. Allegation #7: Staff did not seek timely medical attention for a resident. The complaint states that the facility staff did not provide timely medical attention to resident #3 (R3) while they were under care. It was reported that (R3) experienced several stomach issues and was not given the chance to see a physician. As a result, (R3) was eventually hospitalized and required surgery. No additional details regarding this matter were provided. On May 15, 2025, between 10:00 AM and 2:00 PM, the Department interviewed resident members identified as Resident #1 through Resident #5 (R1-R5). Three (3) out of the five (5) resident members could not corroborate this allegation. (R3) denied being hospitalized or needing any surgery. (R1 and R3-R4) reported that the facility staff responded to residents requiring medical attention and acted promptly. (R2 and R5) they were interviewed, but their health conditions affected their communication ability. Despite this, they made efforts to engage in the conversation. On May 15, 2025, between 10:00 AM and 2:00 PM, the Department interviewed staff members identified as Staff #1 through Staff #4 (S1-S4). Four (4) out of the four (4) staff members could not validate this allegation. (S1) stated that no resident has been hospitalized or requires surgery. (S1-S4) indicated that no residents needed any medical attention that required hospitalization. (S1-S4) also reported that they diligently monitor any resident condition changes. If any significant changes are observed, the protocol is to notify the administrator immediately and to seek prompt medical attention. (Evaluation Report continues LIC 9099-C) After reviewing the Physician's Report LIC 602A for Resident R3 (dated 9/12/22) and the Resident Appraisal LIC603 (dated 3/04/08), it has been confirmed that (R3) is independent, can self-care, has no physical health issues, and is not on any special diet. The Department's audit of (R3)'s service records revealed no hospital records. Additionally, a review of staff training indicates that personnel have completed essential caregiving courses. Based on the information gathered, there is not enough evidence to support the allegation mentioned above. Allegation #11: Staff did not have planned activities for the residents. The complaint alleges that the facility lacked planned activities for residents; no further details were provided regarding this allegation. On May 15, 2025, between 10:00 AM and 2:00 PM, the Department interviewed resident members identified as Resident #1 through Resident #5 (R1-R5). Three (3) out of the five (5) could not support this allegation. (R1, R3, and R4) expressed that planned social activities are available for residents. (R2 and R5) they were interviewed, but their health conditions affected their communication ability. Despite this, they made efforts to engage in the conversation. On May 15, 2025, between 10:00 AM and 2:00 PM, the Department interviewed staff members identified as Staff #1 through Staff #4 (S1-S4). Four (4) out of the four (4) staff members could not corroborate this allegation. Three (3) out of five (5) residents attend a day program daily, Monday through Friday, for half a day, according to staff members (S1-S4). (S1) stated that the facility provides numerous activities for residents in care. (S1) emphasized the importance of tailoring the social activities to each resident's interests. The facility's program includes leisure time, physical exercises, and opportunities for socialization. Residents are offered entertainment, therapy, and outdoor activities catering to their needs. (S1) mentioned that they can choose which daily activities they would like to participate in. (S1-S4) noted that the facility provides an Activities Calendar for residents. On May 15, 2025, between 10:40 AM and 2:00 PM, the Department interviewed Witness #1 (W1), the Program Director at Morningside Adult Day Health. (Evaluation Report continues LIC 9099-C) (W1) confirmed that three (3) residents of the In Honor of Our Parents, Inc. engage in daily social and recreational activities beyond their group home. They explore community arts and cultural events or participate in group outings. These experiences allow them to engage with people and increase their sense of community and connection. These activities are provided to the residents five days a week. The Department reviewed the facility's social activities calendar, which featured several daily events, social activities, and therapy sessions planned for residents in care. Based on the information collected, insufficient evidence supports the allegation mentioned above. Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. While the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegations are determined Unsubstantiated. An exit interview was conducted with Angela Love, and copies of the reports were provided.the state’s words, verbatim · CDSS document, May 16, 2025 · control 11-AS-20240516220152

Allegation investigated: Staff denied a resident access to their personal belongings. Staff denied the residents from being properly fed while in care. Staff did not keep the facility free from rodents. Staff mishandled the resident’s medications. Uncleared staff is providing care and supervision. Staff do not ensure a resident's hygiene need is being met.

On 5/15/25, at 9:00am, the department conducted a complaint visit to the facility and was greeted by Angela Love, Administrator. The department explained the purpose of this visit is to gather information about the complaint, gather facility files, interview staff and residents, and deliver findings for the allegations mentioned above. The investigation consisted of the following: An initial complaint visit was completed by the department on 05/20/2024 to obtain facility files. A subsequent visit was completed by the department on 05/15/2025 to interview staff and residents. The department investigated the allegations mentioned in this complaint; and conducted interviews with staff (S1-S4) and residents (R1-R5) from 10:00am-2:00pm. The following records: Resident Roster (Dated: No Date), Staff Roster (Dated: 04/09/2025), Resident Appraisals (Dated: 9/13/2011, 03/04/2008, 12/08/2023), ID/Emergency Information (Dated: 11/16/2023, 12/8/2023), Physicians Reports (Dated: 09/12/2022, 08/09/2024, 09/12/2022, 08/24/2023, 01/26/2024), Admission Agreement (Dated: 12/08/2023, 11/15/2023, 07/25/2012, 07/25/201310/25/2013), and JML Hospice, Inc (Dated: 04/26/2024) were obtained from the facility. Report Continued on LIC9099-C Unsubstantiated The investigation revealed the following: Allegation #1- Staff denied a resident access to their personal belongings. It is alleged that the resident was not allowed access to their personal belongings such as clothing, pictures, and snacks while living at the facility. On 05/15/25, the department interviewed staff (S1-S4), and residents (R1-R5) from 10:00am-2:00pm about the allegation. 4 of 4 staff denied the allegation that Staff denied a resident access to their personal belongings. All staff (S1-S4) stated that they have never denied any resident access to their own belongings. They further state that all residents in the facility have full access to all of their personal items and are never denied access to them. The department interviewed residents (R1-R5) about the allegation and 3 of 5 residents denied the allegation, while two residents were unable to participate in the investigation due cognitive difficulties. Residents that were interviewed stated that they have access to all of their personal items and the staff has never denied them access to them. The department toured the facility and observed that all residents had full access to their belongings. There were no locks or barriers observed in the resident’s room to prevent them from accessing any items that belonged to them. Based on interviews conducted, there is insufficient evidence to support the allegation that the Staff denied a resident access to their personal belongings. 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. Allegation #2 - Staff denied the residents from being properly fed while in care. It is alleged that the residents are not being provided nutritious and adequate meals at the facility. On 05/15/25, the department interviewed staff (S1-S4), and residents (R1-R5) from 10:00am-2:00pm about the allegation. 4 of 4 staff denied the allegation that Staff denied the residents from being properly fed while in care. All staff (S1-S4) stated that they have never denied any resident any food in the facility. They further state that all residents are provided three nutritional meals per day along with snacks. The department interviewed residents (R1-R5) about the allegation and 3 of 5 residents denied the allegation, while two residents were unable to participate in the investigation due cognitive difficulties. Residents that were interviewed stated that they have never been denied any food at the facility. They further state that they receive as much food as they desire to eat and are not deprived of anything. Report Continued on LIC9099-C The department toured the kitchen area and observed that there is more than enough food to provide for the residents in care. The department observed that there is enough perishable and non-perishable food available, which is stored properly. Based on interviews conducted, there is insufficient evidence to support the allegation that the Staff denied the residents from being properly fed while in care. 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. Allegation #3- Staff did not keep the facility free from rodents. It is alleged that the facility has rodents, and they can access resident’s room because of a rat hole by their bed. On 05/15/25, the department interviewed staff (S1-S4), and residents (R1-R5) from 10:00am-2:00pm about the allegation. 4 of 4 staff denied the allegation that the Staff did not keep the facility free from rodents. All staff (S1-S4) stated that the facility does not have any pests. They state that they have not seen any roaches, mice, rats, or other rodents in the facility. The department interviewed residents (R1-R5) about the allegation and 3 of 5 residents denied the allegation, while two residents were unable to participate in the investigation due cognitive difficulties. Residents that were interviewed stated they have not seen any pests or rodents in their rooms or the facility. The department toured the facility, resident’s bedrooms, and the exterior; and did not observe any pests of any kind. Based on observation and interviews conducted, there is insufficient evidence to support the allegation that the Staff did not keep the facility free from rodents. 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. Allegation #4- Staff mishandled the resident’s medications. It is alleged that the staff overmedicated a resident in the facility because staff thought their behavior would put them at risk. On 05/15/25, the department interviewed staff (S1-S4), and residents (R1-R5) from 10:00am-2:00pm about the allegation. 4 of 4 staff denied the allegation that the Staff mishandled the resident’s medications. All staff (S1-S4) stated that they have not mishandled residents’ medication nor made any errors in giving the medication. They further stated that if an error was to occur, they would notify the resident’s primary physician, family, as well as licensing about the mistake. Report Continued on LIC9099-C The department interviewed residents (R1-R5) about the allegation and 3 of 5 residents denied the allegation, while two residents were unable to participate in the investigation due cognitive difficulties. Residents that were interviewed stated that the staff have never made any errors to their knowledge with their medication. They state that they receive their medication daily. The department reviewed the medication for all residents at the facility and did not observe any evident medication mistakes or errors. Based on records reviewed and interviews conducted, there is insufficient evidence to support the allegation that the Staff mishandled the resident’s medications. 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. Allegation #5- Uncleared staff is providing care and supervision. It is alleged that the facility is allowing staff who have not been cleared to work in the facility by not having a criminal record clearance. On 05/15/25, the department interviewed staff (S1-S4), and residents (R1-R5) from 10:00am-2:00pm about the allegation. 4 of 4 staff denied the allegation that the Uncleared staff is providing care and supervision. All staff (S1-S4) stated that all staff that are working in the facility are cleared to work. They state further that no one is allowed to work until being cleared. The department reviewed all staff files and cross checked those files with our own, and did not observe any discrepancies. Each staff file was incompliance with Title 22 regulations and had the required documentation. Based on records reviewed and interviews conducted, there is insufficient evidence to support the allegation that the Uncleared staff is providing care and supervision. 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. Allegation #6- Staff do not ensure a resident's hygiene need is being met. It is alleged that the resident’s hygiene needs are not being met because staff are not ensuring that the residents are assisted with all activities of daily living. On 05/15/25, the department interviewed staff (S1-S4), and residents (R1-R5) from 10:00am-2:00pm about the allegation. 4 of 4 staff denied the allegation that the Staff do not ensure a resident's hygiene need is being met. All staff (S1-S4) stated that they do ensure that all resident’s hygiene requirements are met. They further state that each resident is bathed daily, along with grooming, dressing, shaving, and personal care. The department interviewed residents (R1-R5) about the allegation and 3 of 5 residents denied the allegation, while two residents were unable to participate in the investigation due cognitive difficulties. Residents that were interviewed stated that the staff does ensure that their hygiene needs are met daily. They state further that they are satisfied with the care and supervision they are receiving from the staff. Based on interviews conducted, there is insufficient evidence to support the allegation that the Staff do not ensure a resident's hygiene need is being met. 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. No citations were issued for this complaint. An exit interview was conducted, and a hard copy of this Complaint Investigation Report was provided to Angela Love, Administrator.the state’s words, verbatim · CDSS document, May 15, 2025 · control 11-AS-20240516220152

Allegation investigated: Staff did not prevent a resident from developing pressure injuries Staff do not have adequate record keeping.

On May 15, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPAs) Ernand Dabuet and Perry Scott conducted a subsequent visit to gather information regarding the above allegations. LPA met with the administrator, Angela Love, and explained the purpose of the visit. LPAs were granted entry to the facility. The investigation consisted of the following: An initial complaint visit was completed by the Department on 05/20/24 to obtain facility files. The Department conducted A subsequent visit on 05/15/25 to interview staff and residents. The Department investigated the allegations mentioned in this complaint and conducted interviews with staff (S1-S4), residents (R1-R5), and witnesses (W1-W3). The following records: Resident Roster, Staff Roster, Resident Appraisals (dated 09/13/1, 03/04/08, 12/08/23), IID/Emergency Information (dated 11/16/23, 12/08/23), Physicians Reports (dated 09/12/22, 08/09/24, 09/12/22, 08/24/23, 01/26/24), and other records pertinent to this complaint. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Staff did not prevent a resident from developing pressure injuries. The complaint alleges that the facility staff did not prevent Resident #1 (R1) from developing pressure injuries. It is reported that the residents in care developed pressure injuries that could have been prevented by staff. According to reports, (R1) developed two wounds, categorized as stage 2 and stage 3. No additional information was provided regarding these allegations. A review of Resident #1 (R1)’s Identification and Emergency Information LIC 601 (dated November 11, 2023) indicates that (R1) was admitted to In Honor of Our Parents, Inc. on that date. Previously, (R1) was on Benevolent Home Health from July 09, 2024, through September 01, 2024. During (R1)’s home health treatment services, (R1) was not diagnosed with any pressure injuries. (R1) Home health services were to assist with Activities of Daily Living (ADLs). On May 15, 2025, between 10:00 AM and 2:00 PM, the Department interviewed resident members identified as Resident #1 through Resident #5 (R1-R5). Three (3) out of the five (5) denied ever having pressure injuries. (R1) asserted to have never had any bed sores. (R2 and R5) were interviewed, but their health conditions hindered their ability to engage in conversation. Despite the effort to communicate, their medical condition limited their dialogue. On May 15, 2025, between 10:00 AM and 2:00 PM, the Department interviewed staff members identified as Staff #1 through Staff #4 (S1-S4). Four (4) out of the four (4) staff members could not corroborate this allegation. Staff members (S1-S4) reported that no residents in care have ever developed bedsores. (S1) stated that residents in care have static air mattresses that prevent pressure sores due to limited mobility. Residents are repositioned every two hours to prevent pressure injuries, and staff received training from hospice and home health on how to avoid these injuries. On May 13, 2025, and May 15, 2025, between 10:40 AM and 2:00 PM, the Department interviewed witness members identified as Witness #1 through Witness #3 (W1-W3). Three (3) out of the three (3) witness members could not verify the allegation. (W1) the Program Director at Morningside Adult Day Health, characterized (R2, R3, and R5) all to be well groomed and cared for by staff and unaware of bedsores. (W2 and W3) Home Health Services representatives verified that (R1) was never treated for pressure injuries and that no wound care plan was ever established to be included in (R1’s) care plan. (Evaluation Reports continues LIC 9099-C) The Department reviewed Resident #1's (R1) Physician's Report LIC 602A, (dated 08/24/24) and the Resident Appraisal (dated 11/16/23). These documents indicated that (R1) had no history of skin conditions or breakdowns. Additionally, an examination of the Physician Reports LIC 602A for Residents #2 through #5 (dated 09/12/22, 01/26/24, and 08/09/24) showed no history of skin conditions or breakdowns for any of these residents. A further review of (R1)'s medical records from Benevolent Home Health (covering 07/09/24 to 09/01/24) confirmed that (R1) had not received treatment for any pressure injuries nor was there was an established wound care include in the care plan. During a May 15, 2025, visit the Department observed that the facility provided residents with static air mattresses. Based on the information collected, insufficient evidence supports the allegation mentioned above. Allegation #9: Staff do not have adequate record keeping. The complaint alleges that the facility failed to maintain accurate records of staff and residents. No further details were provided regarding this allegation. On May 15, 2025, between 09:30 AM and 12:00 PM, the Department thoroughly audited the resident records for individuals designated as Resident #1 through Resident #5. Upon review, it was discovered that each resident's service record was maintained and included all necessary documents mandated by the Community Care Licensing regulations. This review ensured that the residents' files complied with the established legal requirements. On May 15, 2025, between 09:30 AM and 12:00 PM, the Department thoroughly audited the staff records for individuals designated as Staff #1 through Staff #4. An examination revealed that each staff member's record was maintained correctly and included all required documents specified by Community Care Licensing regulations. This review confirmed that the staff files adhered to the established legal standards. Based on the information collected, insufficient evidence supports the allegation mentioned above. Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. While the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegations are determined Unsubstantiated. An exit interview was conducted with Angela Love, and copies of the reports were provided.the state’s words, verbatim · CDSS document, May 15, 2025 · control 11-AS-20240516220152

Type of visit: Required - 1 Year

On 7/18/2024, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Angela Love/Administrator. LPA explained the purpose of today’s visit. The facility is licensed to serve (6) elderly adults ages 60 and above, of which (6) can be non-ambulatory and (1) Bedridden on room #5. The facility has an approved hospice waiver for (1). Facility shall have awake staff 24/7. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident rooms, two (2) bathrooms, living room, dining room, den, and kitchen, room in the attic upstairs for staff, and outside patio area. LPA toured the physical plant. There were no bodies of water or obstructions on the premises. LPA Iniguez and the Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. LPA inspected a total of (4) bedrooms and (2) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were found to be within Title 22 regulations and were operational. Smoke and carbon monoxide detectors were in operable condition. The water temperature ranged from 113.5°F to 115.2°F, and the room temperature ranged from 76°F to 78°F. The evaluation Report continues on the next page, LIC 809-C, providing further details of the inspection findings. During the visit, LPA Iniguez observed that the facility was clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The kitchen was inspected, and there was sufficient perishable and non-perishable food available, which was adequately maintained. All fire extinguishers were charged and operable. The last Fire/Disaster Drills were conducted on 4/1/24. A review of (3) residents' service files and (3) staff personnel files was maintained in order. Facility does not use Medication Administration Records (MARs). LPA observed the facility's infection control practices. All mandated inspection control posters were displayed throughout the facility. A copy of liability insurance was emailed to LPA. Facility Annual Fess current. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies; therefore, no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Angela Love / Administratorthe state’s words, verbatim · CDSS document, Jul 18, 2024