Kathryn Jane Residential Care Facility

Allegation investigated: Facility staff do not accord resident privacy during therapy sessions Facility staff speak inappropriately to resident Facility staff do not treat resident with dignity

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegations. LPA met with Staff #1 (S1) Edilma Avendano and explained the reason for today’s inspection. The investigation into the allegations that facility staff do not accord resident privacy during therapy sessions, facility staff speak inappropriately to resident, and facility staff do not treat resident with dignity revealed the following: During the course of the investigation, LPA inspected the facility, interviewed Administrator (AD) Alfonso Avendano, staff, witnesses, and residents, and obtained and reviewed copies of the resident roster, staff roster, and resident vaccination records. CONTINUED Unsubstantiated Regarding the allegation that facility staff do not accord resident privacy during therapy sessions: it was alleged that AD demanded to know the details of R1’s confidential sessions with their therapist, engaged in inappropriate behavior with R1’s therapist when they refused to share confidential information with AD, and has made it difficult for R1’s therapist to conduct private therapy sessions with R1 at the facility. LPA interviewed AD who denied the allegation, stating that R1’s therapy sessions are private, AD has not received any confidential information, and AD has never tried to interfere with these therapy sessions or invade R1’s privacy. Per AD, they did try to coordinate with R1’s therapist regarding R1’s mental health for the purpose of helping to support R1, but R1’s therapist refused and AD accepted their response. LPA interviewed S1 who was unable to provide information regarding the allegation. LPA interviewed one additional staff who did not corroborate the allegation. LPA interviewed R1 who was unable to provide information regarding this allegation. LPA interviewed the four other residents who did not report any concerns at the facility. LPA interviewed R1’s responsible party who was aware of the reported concerns regarding R1’s therapy sessions, was unable to provide additional information, and stated that their only concern is that they had a disagreement with AD regarding the use of medications to treat R1’s mental health concerns. Regarding the allegation that facility staff speak inappropriately to resident: it was alleged that AD provided misinformation and spoke extensively about their negative personal opinions on vaccines, instilling fears in R1 and other residents. LPA interviewed AD who denied the allegation, stating that all residents were vaccinated for COVID-19, they did not try to stop residents from getting vaccines, and they did not make anti-vaccine remarks to residents. LPA reviewed resident vaccination records which confirmed that all residents received COVID-19 vaccinations. LPA interviewed S1 who was unable to provide information regarding the allegation. LPA interviewed one additional staff who did not corroborate the allegation. LPA interviewed R1 who was unable to provide information regarding this allegation. LPA interviewed the four other residents who did not report any concerns at the facility. LPA interviewed R1’s responsible party who did not provide information corroborating the allegation and stated that their only concern is that they had a disagreement with AD regarding the use of medications to treat R1’s mental health concerns. CONTINUED Regarding the allegation that facility staff do not treat resident with dignity: it was alleged that facility staff do not acknowledge R1’s thoughts and feelings and treated R1 like they are mentally ill, which has harmed R1’s emotional wellbeing. LPA interviewed AD who denied the allegation, stating R1 has emotional episodes during which R1 disturbs the atmosphere and makes accusations against staff and other residents, during these episodes AD spends time gently redirecting R1, and AD has worked with R1’s responsible party to address R1’s mental health concerns. Per AD, AD and R1’s responsible party have a disagreement on the use of medications to address R1’s mental health concerns. LPA interviewed S1 who was unable to provide information regarding the allegation, but stated that R1 and their family were happy with the facility, R1 stayed at the facility long after this issue was reported, and R1’s family referred a current resident to the facility. LPA interviewed one additional staff who did not corroborate the allegation. LPA interviewed R1 who confirmed they do not feel like they are treated well at the facility. LPA interviewed the four other residents who did not report any concerns at the facility. LPA interviewed R1’s responsible party who confirmed that they had a disagreement with AD regarding using medications to address R1’s mental health concerns, but did not provide information corroborating the allegation and did not allege that AD failed to follow R1’s doctor’s orders. The information obtained is conflicting. Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Jan 26, 2026 · control 22-AS-20210824152139

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by administrator Alfonso Avendano. There are currently four residents in care, one of which is receiving hospice care at this time. Residents are observed relaxing in the facility's common areas or in their respective bedrooms. LPA accompanied by facility staff toured the physical plant. The facility is a two-story house with four private bedrooms and one shared bedroom (two of which are vacant). There are two shared bathrooms used by residents. None of the residents are bedridden at this time. The facility's second floor is for use by the licensee's family and staff exclusively. No residents or signs of resident occupancy observed upstairs. All occupied and vacant bedrooms appear clean and sanitary. Two residents use half-length rails for postural support, with physician orders reviewed to be on file. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are equipped with grab bars and slip mats. Hot water temperature measured at 108F at a sink used for personal grooming. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning supplies and the medication central storage are verified to be secure. There are two wall-mounted fire extinguishers present, both verified to be charged with up-to-date maintenance tags. Carbon monoxide and smoke detectors were found to be present and operational. Emergency food and water supplies are observed to be stored in the garage. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA and facility staff toured the outside of the facility. LPA observed multiple shaded outdoor seating area with outdoor furniture for resident use. The identified routes of egress is free of clutter and obstructions. There are self-latching gates on both sides of the premises. There are no bodies of water present. The facility does not utilize locked perimeters or delayed egress. LPA reviewed four resident records which included all necessary components. LPA reviewed resident medication records and prescription orders with no discrepancies observed. Consultation provided on the updated requirements for an annual visit with a primary care provider. LPA reviewed staff records for three staff members during the visit. Proof of current CPR training reviewed. Disaster drills are conducted quarterly. Most recent drill is documented. All staff members are verified to be background cleared and associated to the licensed location. The administrator certificate is current. Renewal material submitted and reviewed. Based on the observation conducted during the present visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to a facility representative.the state’s words, verbatim · CDSS document, Oct 6, 2025

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by administrator Alfonso Avendano after stating the purpose of the visit. LPA accompanied by administrator conducted a tour of the physical plant and observed the following: the facility is a two-story home with an attached garage. The upper level is only for use by licensee and staff and is kept inaccessible to residents. The facility has five bedrooms including a master bedroom which can be shared and four private bedrooms, There are two bathrooms including the en-suite bath of the master bedroom. All bathrooms are observed to be equipped with grab bars and slip mats. All resident bedrooms have the required furnishings. Bathrooms faucets and toilets are operational. Water temperature was measured at 107.5F in the shared bathroom. LPA observed all beds have linen and blankets. There are half rails used for postural supports in three of the private bedrooms. Physician orders for all three residents reviewed. There are currently five residents admitted to the facility, none of which are receiving hospice care. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Drills are conducted quarterly and documented. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke and carbon monoxide detectors tested operational. Fire extinguisher present is fully charged and has been maintained in 2024. There is adequately shaded outside space with outdoor furniture present. There are self-latching gates on each side of the property. The routes of egress are free of obstructions. Medication, cleaning products and sharp items are confirmed to be inaccessible throughout the physical plant. The medication central storage was also observed to be secure and reviewed to be accurate and up to date with the resident's prescription orders. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA reviewed five resident files along with four staff files. Resident records include all necessary components. Two consultations provided as one admission agreement is observed to be initialed throughout but missing signatures and one physician report update for a resident diagnosed with dementia is still appearing to be pending after being requested in August 2024. All staff members on the facility's roster are confirmed to be cleared and associated with this particular licensed location. Training and CPR training verified to be up to date. Health screenings are on file for all staff members. Facility practices and trains staff on infection control measures, however they are not materialized in an Infection Control Plan. A copy of licensing form LIC9282 provided during the visit along with a consultation from LPA. Personal rights poster PUB475 is not observed to be posted as the facility only has the poster for the Long-Term Care Ombudsman information posted. A consultation was provided along with an electronic copy of the poster. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Four consultations provided. An exit interview was conducted and a copy of this report was provided to a facility representative.the state’s words, verbatim · CDSS document, Oct 16, 2024

The state marks this report as 6 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.