Kevinberg Care Home

Type of visit: Case Management - Legal/Non-compliance

A Non-Compliance Conference (NCC) was conducted today on September 01, 2026, at Regional Office with the Sacramento South Regional Office. Present at today's meeting include the following: Regional Manager Stephenie Doub, Licensing Program Manager Stephen Richardson, and Licensing Program Analyst Pang Lee. Facility Representatives: Licensee/Administrator Fernando Paz Maramo and Regional Ombudsman Representative Sofia Diaz Terrazas. The Non-Compliance Conference process was explained during this meeting; also, to include the administrative process. In the last year, the facility has been cited a total of seven times. The facility received two A citations and five B citations. The citations consist of the following: care and supervision, basic services, reappraisal- change in condition, eviction and reporting requirements. Issues Discussed During the Noncompliance Conference: · Complaint No. 27-AS-20260428150655 regarding lack of care and supervision. · Reporting requirements. · Facility policies and procedures regarding resident assessments, monitoring, and changes in condition. · Eviction requirements and procedures. CONTINUED LIC 809-C · Residents’ Needs and Services Plans. · Procedures to follow when a resident experiences a change in condition and the facility can no longer meet the resident’s needs, including: o Meeting with the resident and the resident’s responsible person. o Issuing an appropriate eviction notice in accordance with applicable requirements. o Reassessing the resident’s needs and determining whether the facility can continue to provide the necessary care and supervision. · The facility’s resident admission process, including: o Completing a pre-admission appraisal. o Reviewing the prospective resident’s hospital and medical records. o Meeting with the prospective resident and family or responsible person to obtain relevant information. o Maintaining ongoing communication with the resident’s family or responsible person. o Documenting all communications with the resident’s responsible person and healthcare providers. o Understanding the purpose of and differences between the resident appraisal and the Needs and Services Plan. CONTINUED LIC-C · Additional staff training regarding: o Eviction procedures. o Changes in residents’ conditions. o Wound care, including the identification of Stage 1 and Stage 2 pressure injuries. The facility has stated they will do the following to achieve continued and substantial compliance: · Complete Technical Support Program (TSP) services · Complete additional training on eviction requirements and procedures through an approved vendor with CCLD. · The facility will report incident reports to the department via fax number 916-263-4744 or CCLASCPSacramentoRo@dss.ca.gov. · Complete additional training on wound care through an approved vendor with CCLD. · Develop and submit a written plan describing (Due by September 15, 2026, end of day 5:00 PM): - How residents will be assessed and monitored for skin conditions. - How frequently residents’ skin will be checked. - How skin assessments and observations will be documented. - The actions staff will take when a wound, skin breakdown, or other irregularity is identified. In addition, at this meeting the Licensee and facility management were advised future non-compliance regarding the above and other regulatory components will result in additional citations, civil penalties, and further potential administrative action. CONTINUED LIC 809-C Community Care Licensing Department (CCLD) will do the following: · Increase monitoring to quarterly visits for 2 years or until concerns are resolved. · Technical Support Program (TSP). A referral was completed by CCLD. · Reduce hospice waivers from six to two · LPA Lee will provide Licensee Maramo the Non-Emergency PIN ASC 24-05 by September 03, 2026, end of day. · LPA Lee will provide Licensee Maramo CCLD approved vendor information by September 03, 2026, end of day. Completing the Non-Compliance Conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager. Per California Code of Regulations (CCRs) - Title 22 no deficiencies are being cited at this visit. An exit interview was conducted with Administrator Maramo and a copy of this report was provided at the end of the meeting.the state’s words, verbatim · CDSS document, Sep 1, 2026

Allegation investigated: Staff leave resident seated in wheelchair for extended periods of time Due to staff neglect, resident developed pressure injuries Unlawful eviction

On 08/13/2026, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with Administrator Fernando Paz Paramo and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the above allegations. The current census is four. A brief interview was conducted with Administrator Paramo. It was alleged that staff leave residents seated in wheelchairs for extended periods of time. The investigation consisted of interviews with facility staff, residents in care, and outside agencies, as well as record reviews and observations. Administrator Paramo stated that Resident 1 (R1) uses a wheelchair and requires staff assistance with transfers between the bed and wheelchair. Interviews with three out of four resident stated that they are "alaways just sitting" and R2 stated, "I am always sitting here and my wheelchair." Two out of two outside agencies interviewed reported concerns regarding residents remaining seated for extended periods. CONTINUED LIC 9099-C Substantiated Outside Agency 1 (OA1) stated that after leaving the facility with R1 for an appointment and returning approximately seven to eight hours later, OA1 observed the other residents seated in the same locations as when OA1 had left. Outside Agency 2 (OA2), who visits the facility for several hours approximately once a week, reported that residents were typically observed sitting and watching television and that R1 was consistently observed seated in a wheelchair in the living room. Additionally, during LPA Lee's facility visits on 04/30/2026 from approximately 8:25 AM to 11:00 AM, 07/10/2026 from approximately 10:11 AM to 11:22 AM, and during today's visit, residents were observed seated in the living room with limited activity observed during the visits. Based on interviews and observations, there is sufficient evidence to support that residents, including R1 who require staff assistance with transfers, routinely remained seated and seated in their wheelchair for extended periods. Therefore, the preponderance of evidence standard has been met, and the allegation is substantiated. It was alleged that due to staff neglect a resident developed pressure injuries. This investigation consisted of records reviewed, interviews with staff, residents, and the residents in care and outside agencies. Based on the investigation it was learned that on 04/23/2026, R1 was hospitalized and diagnosed with two unstageable pressure injuries on R1’s coccyx and ischium. Home health care records show that as of 04/13/2026, when home health services began, R1 had no pressure injuries. Moreover, care staff 1 (S1) and Administrator Paramo stated they were unaware of any pressure injuries. Upon admission to home health, R1 was assessed as needing assistance with repositioning. Home health staff provided the facility with instructions on repositioning and directed staff 1 to report any skin breakdown immediately and S1 acknowledged that R1 required assistance to turn in bed and stated that Administrator Paramo helped reposition R1. In contrast, Administrator Paramo reported that R1 could turn themself and did not require repositioning. After being notified of R1’s diagnoses, both S1 and Administrator Paramo attributed the injuries to R1 scratching their own blisters. R1 required assistance with incontinence care, meaning facility staff had direct opportunities to observe R1’s skin condition before the injuries progressed to an unstageable level therefore, based on the evidence, the preponderance of evidence standard is met, and the allegation is substantiated. It was alleged that staff unlawfully evicted a resident. The investigation consisted of interviews with Administrator Paramo and facility staff, and a review of relevant records. CONTINUED LIC 9099-C The investigation revealed that R1 was issued a 30-day eviction notice dated 03/17/2026, which stated the reason for eviction as, “level of care is higher and needs more professional care.” However, record review revealed that a pre-appraisal was not completed prior to R1’s admission on 06/24/2023, and there was no Needs and Services Plan in place and on file for R1. Additionally, there was no documented reappraisal or change in R1’s condition demonstrating that R1’s care needs had increased to a level that the facility could no longer meet, including documentation related to R1’s hospital visits. Although the facility cited R1’s increased care needs and need for a higher level of care as the basis for eviction, the facility did not have a documented reappraisal demonstrating a change in R1’s condition or establishing that R1’s needs could no longer be met by the facility. Furthermore, the eviction notice did not include required information, including a relocation evaluation, a list of referral agencies, information regarding R1’s or R1’s legal representative’s right to contact the Department to investigate the reasons for the eviction pursuant to Health and Safety Code Section 1569.35, and the address and telephone number of the local Long-Term Care Ombudsman. Administrator Paramo acknowledged that R1 and R1’s responsible party were not provided a copy of R1’s current service plan because a service plan had never been completed. Based on interviews and record review, sufficient evidence was obtained to corroborate the allegation. Therefore, the preponderance of evidence standard is met, and the allegation that staff unlawfully evicted R1 is substantiated. At the time of the complaint visit, an immediate civil penalty of $500 was issued, and Administrator Paramo was informed that an additional civil penalty was pending review and may be assessed according to Health and Safety Codes 1569.49(f). Once a civil penalty has been determined, the Department will return at a future date to assess civil penalty. As a result due to staff neglect, a resident developed pressure injuries (serious bodily injury) while in care of the facility. An exit interview was conducted, and a copy of this LIC 9099 report, LIC 421 IM and appeal rights were provided to the Administrator Paramo. Failure to correct the deficiencies may result in civil penalties. It was learned that the facility does not document or log when the residents use the toilet or is changed other than that residents are checked every two hours. Moreover, during LPA Lee’s facility visits on 04/30/2026, 07/10/2026 and during today’s visit LPA Lee did not observe any incontinence odor in the facility. Therefore, the preponderance of evidence standard has not been met, and the allegation is unsubstantiated. It was alleged that due to staff neglect, a resident developed sepsis. This investigation consisted of records reviewed, interviews with staff, the residents in care and outside agencies. It was learned that R1 had multiple hospital visits between March and April 2026 due to fluid-filled blisters associated with bullous pemphigoid. Administrator Paramo and S1 stated that R1’s condition continued to worsen despite prescribed treatment. Both reported that R1 frequently removed bandages and scratched the affected areas despite redirection. Administrator Paramo and S1 believed R1 required a higher level of care, and R1 was issued an eviction notice prior to receiving home health services. R1’s home health Registered Nurse (RN) stated that facility staff were adequately managing R1’s wounds. Although R1’s bandages were sometimes wet during wound care visits, the RN considered this normal and did not believe more frequent bandage changes were necessary. The RN also reported observing no signs of infection. On 04/22/2026, R1 appeared to be at baseline; however, on 04/23/2026, R1 was hospitalized and diagnosed with sepsis. Based on interviews and information obtained, facility staff assisted with R1’s wound care, sought a higher level of care, and provided care consistent with the home health RN’s expectations. Although R1 was subsequently diagnosed with sepsis, there is insufficient evidence to establish that facility staff neglect to provide appropriate care or contribute to R1’s condition. Therefore, the preponderance of evidence standard has not been met, and the allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy of this LIC 9099 report was provided to the Administrator Paramo.the state’s words, verbatim · CDSS document, Aug 13, 2026 · control 27-AS-20260428150655

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.312(a) · Plan of correction due date: Aug 20, 2026

§1569.312(a) Basic services requirements Type A (a) Care and supervision as defined in Section This was not met as evidenced by Based on records review, observations, and interviews, the Licensee did not ensure R1's basic services and needs were being met. Residents are left seated for seated for extended periods of time. This posed an immediate health and safety risk to R1.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: Administrator will review the regulation cited and provide LPA Lee with a statement of reviewing and understanding the regulation cited. POC due by end of day 8/20/2026 5:00 PM

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Aug 27, 2026

87464(f)(1) Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This was not met as evidenced by Based on records review, observations, and interviews, the Licensee did not ensure R1's basic care and supervision needs were being met which led to R1 developing pressure injuries. This posed an immediate health and safety risk to R1.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: The Administrator agrees to conduct a basic services training course for all staff through an approved vendor with CCLD. Administrator will email LPA Lee documents used for training, training sign in sheet as well as a statement of reviewing and understanding the regulation cited. POC due by end of day 08/27/2026 5:00 PM

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a)(4) · Plan of correction due date: Aug 27, 2026

87224(a)(4) Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days’ written notice to the residents is required except as otherwise specified in paragraph (5)... This was not met as evidenced by Based on review and interview records, the licensee did not ensure that a lawful eviction was given to R1. This posed a potential health and safety risk to R1.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: Administrator agrees to ensure review the eviction regulation cited and provide LPA Lee with a statement of reviewing and understanding the regulation cited. POC due by end of day 08/27/2026 5:00 PM

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Pang Lee arrived at the facility unannounced on 08/13/2026 to conduct a case management visit. LPA Lee met with Administrator Fernando Paz Paramo and explained the purpose of the visit. A brief interview was conducted with Administrator Paramo. The purpose of the visit was to follow up on deficiencies identified during complaint investigation control number 27-AS-20260428150655. During the investigation, it was learned that Resident 1 (R1) was admitted to the facility on 06/24/2023. Record review revealed that the facility did not have documentation demonstrating that a pre-admission appraisal was completed prior to R1's admission. R1's LIC 603A Resident Appraisal documented that R1 was in good health, did not use a wheelchair, and did not require assistance with transferring or turning in bed. The facility also did not have a Needs and Services Plan in place identifying R1's care and service needs. The investigation further revealed that R1 subsequently experienced changes in care needs. Administrator Paramo and Staff 1 (S1) acknowledged that R1's care needs had increased. Additionally, on 03/17/2026, the facility issued R1 a 30-day eviction notice stating that R1's “level of care is higher and needs more professional care,” further documenting the facility's awareness that R1's care needs had changed. However, record review revealed no documentation demonstrating that R1 was reappraised or that R1's appraisal and care needs were updated to reflect the change in condition, including changes associated with R1's hospitalization. Moreover, Administrator Paramo acknowledged that the pre-admission appraisal, Needs and Services Plan, reappraisal, and incident reports had not been completed and reported to CCLD. CONTINUED LIC 809-C During today's visit, LPA Lee provided Administrator Paramo the following forms and explained what the forms are used for: 1. LIC 603 Replacement Appraisal Information 2. LIC 603A Resident Appraisal 3. Resident Reappraisal 4. LIC 625 Needs and Service Plan 5. LIC 624 Incident Report ( LPA Lee provided Administrator Paramo CCLD's fax number and email for reporting) 6. An Examplet/Template of Progress Note/Charting Notes Based on interviews conducted and records reviewed and obtained during the investigation, deficiencies were observed and cited pursuant to the California Code of Regulations, Title 22, and the California Health and Safety Code. The deficiencies are documented on the LIC 809-D. Failure to correct the deficiencies may result in civil penalties. An exit interview was conducted with Administrator Paramo. A copy of the LIC 809, LIC 809-D, and appeal rights were provided to the facility.the state’s words, verbatim · CDSS document, Aug 13, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Aug 27, 2026

87457(c) Pre-Admission Appraisal (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria ... This requirement was not met as evidenced by: Based on record review and interviews, the Licensee did not ensure that R1 had a completed pre-appraisal prior to admission to the facility on 06/24/2023. This posed a potential health and safety risk to R1.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: The Administrator agrees to ensure that a pre-appraisal is completed prior to admitting any resident to the facility. The Administrator will review the regulation cited and submit a written statement to LPA Lee confirming that the regulation has been reviewed and understood. POC is due by 08/27/2026 at 5:00 PM.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87467(a) · Plan of correction due date: Aug 27, 2026

87467(a) Resident Participation in Decision making (a) Prior to, or within two weeks of the resident’s admission, the licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident’s preferences regarding the services provided at the facility. This requirement was not met as evidenced by: Based on record review and interviews, the Licensee did not ensure that R1 had a complete Needs and Services Plan in place. This posed a potential health and safety risk to R1.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: The Administrator agrees to ensure that a completed Needs and Services Plan is maintained for each resident in care. The Administrator will complete a Needs and Services Plan for all residents currently in care and email copies to LPA Lee. Additionally, the Administrator will review the regulation cited and submit a written statement to LPA Lee confirming that the regulation has been reviewed and understood. POC is due by 08/27/2026 at 5:00 PM.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: Aug 27, 2026

87463(a) Reappraisals (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement was not met as evidenced by: Based on record review and interviews, the Licensee did not ensure that a reappraisal was completed for R1 following a change in R1’s condition and being admitted to the hospital. This posed a potential health and safety risk to R1.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: The Administrator agrees to ensure that a reappraisal is completed for each resident when there is a change in the resident’s condition. The Administrator will review the regulation cited and submit a written statement to LPA Lee confirming that the regulation has been reviewed and understood. POC is due by 08/27/2026 at 5:00 PM.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: Aug 27, 2026

87211(a)(1) Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (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... This requirement was not met as evidenced by: Based on record review and interviews, the Licensee did not ensure that required incident reports were completed and submitted to the Department and that R1’s responsible party was notified when R1 was hospitalized, experienced a change in condition, and sustained pressure injuries. This posed a potential health and safety risk to R1.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: The Administrator agrees to ensure that all required incident reports are completed and submitted to the Department and that residents’ responsible parties are notified as required. The Administrator will review the regulation cited and submit a written statement to LPA Lee confirming that the regulation has been reviewed and understood. POC is due by 08/27/2026 at 5:00 PM.

Type of visit: Required - 1 Year

On 10/10/2025, Licensing Program Analyst (LPA) Cynthia Tamayo made an unannounced visit to this facility to conduct an annual inspection. LPA identified herself upon arrival, stated the purpose of the visit and asked to meet with the Designated Facility Administrator. LPA met with Fernando Paramo (Administrator certificate # 7007018740, expiration date of 12/27/26) and a brief interview followed. The facility is licensed to serve adults age range 60 and over. Approved for six (6) non-ambulatory. Hospice approved for six (6). The current census is 5. LPA and DFA inspected the physical plant inside and outside to ensure there were no health and safety concerns. LPA observed the facility to be free of odor, clean and in good repair at this time. LPA observed required furniture and lighting throughout the facility. LPA observed the common areas including the kitchen areas, dining area. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. Refrigerators and freezers were observed to store adequate amount of food. Temperatures for refrigerators and freezers were observed to be within regulatory standard as per observation and review of temperature log. Centrally stored medications, toxins, and sharp knives kept locked and inaccessible to residents. The facility temperature inside the facility measured between 68 and 78 degrees Fahrenheit. All resident bedrooms and found that they each had the required furniture, furnishings, and lighting to be in compliance at the present time. Continued on 809-C The fire extinguisher was last inspected 3/14/2025. The hot water measured 111.5 degrees and was in compliance at the time of inspection which is between 105 and 120 degrees Fahrenheit title 22 regulations This LPA then conducted an inspection of the exterior of the facility. There were no bodies of water present and the back yard was completely fenced in. There was a shaded area with furniture for all residents to use. All windows and screens were in good repair at the time of inspection. A review of the facility perimeter fence, side gates, and exits was also conducted. LPAs reviewed 4 staff files include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. LPA reviewed the resident files for the 5 residents in care to ensure that they contained the required documents. The following documents were collected during today's visit: LIC 308 Designation of Administrative Responsibility, Proof of Current Liability Insurance, Resident Roster, LIC 500 Personnel Report and Staff Schedule for October 2025, LIC 9020 Resident roster. According to the California Code of Regulations, Title 22, no deficiencies were cited during today's visit. A copy of this report was provided and an exit interview was conducted.the state’s words, verbatim · CDSS document, Oct 10, 2025

Type of visit: Collateral

On 8/14/2025 Licensing Program Analyst (LPA) Shakaricka Hughes conducted an unannounced collateral visit to Kevinberg Care Home. The purpose of the visit was to conduct a complaint interview with a resident in care unrelated to this care home. LPA Hughes observed 3 residents in the common area watching television. Another resident was in their room being changed. LPA conducted an interview with resident (R1). Exit interview. Copy of report provided to facility representative. No Deficiencies observed.the state’s words, verbatim · CDSS document, Aug 14, 2025

Type of visit: Required - 1 Year

On 10/30/24, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to conduct an annual inspection. LPA identified herself upon arrival, stated the purpose of the visit and asked to meet with the Designated Facility Administrator. LPA met with Fernando Paramo (Administrator certificate # 6022894740, expiration date of 12/27/24) and a brief interview followed. LPA began inspection in the kitchen. LPA observed all sharps and medications were locked and inaccessible to residents in care. LPA observed enough food items for 7 days perishable and 2 days non-perishable. LPA inspected all 3 resident bedrooms and found that they each had the required furniture, furnishings, and lighting to be in compliance at the present time. The fire extinguisher was last inspected on 03/18/24 by Fire Code Equipment Safety Co. The hot water temperature was measured to ensure it was between 105 and 120 degrees Fahrenheit. The hot water measured 119.8 degrees and was in compliance at the time of inspection. LPA reviewed medications, Centrally Stored Medication Record, and the Daily Medication Log along with ensuring the first aid kit had all the required items to be in compliance. This LPA then conducted an inspection of the exterior of the facility. There were no bodies of water present and the back yard was completely fenced in. There was a shaded area with furniture for residents to enjoy. All windows and screens were in good repair at the time of inspection. LPA reviewed the resident files for the 3 residents in care to ensure that they contained the required documents. LPA then reviewed staff files to ensure all required materials were included and that all care staff had their back ground clearances. According to the California Code of Regulations, Title 22, no deficiencies were observed or cited during today's visit. A copy of this report was provided and an exit interview was conducted.the state’s words, verbatim · CDSS document, Oct 30, 2024

Allegation investigated: Staff attempted to suffocate resident in care. Staff sexually abused resident in care. Staff hold resident against her will. Staff does not allow resident to get off bed. Staff does not allow resident to make phone calls. Staff does not allow resident to have contact with people.

On 7/18/24, Licensing Program Analyst (LPA) Tung Truong arrived unannounced to deliver the findings for a complaint received on 5/14/24. LPA met with Administrator Fernando Paramo and explained the purpose of the visit. Throughout the course of the investigation, the Department conducted interviews and reviewed records. Based on records review, and staff and resident interviews, there is insufficient evidence to substantiate the allegations mentioned above. The Department interviewed 4 out of 5 residents residing in the facility. Based on resident interviews, 3 out of 5 residents stated their personal rights were not being violated. Residents reported they were not being held against their will. Residents reported they were allowed to make phone calls and have contact with their families. Residents stated they feel safe and have no concerns with staff or care. Continued on 9099-C Unsubstantiated Based on staff interviews, staff (S1) denied the allegations mentioned above, stating that he never attempted to suffocate or sexually abuse resident (R1) at any time. Moreover, residents and staff denied witnessing or knowing of any physical or verbal abuse taking place in the care home. Furthermore, the investigation revealed that R1 is diagnosed of dementia and suffers from confusion, disorientation, and inappropriate behavior. As a result of this investigation, the Department finds the allegation above to be UNSUBSTANTIATED- A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and a copy of the report was provided upon exit.the state’s words, verbatim · CDSS document, Jul 16, 2024 · control 27-AS-20240514101217

Allegation investigated: Staff caused an injury to a resident Staff inappropriately touches the residents Staff mishandled a resident Staff does not properly feed a resident

On 7/16/24, Licensing Program Analyst (LPA) Tung Truong arrived unannounced to deliver the findings for a complaint received on 5/21/24. LPA met with Administrator Fernando Paramo and explained the purpose of the visit. Throughout the course of the investigation, LPA conducted interviews and reviewed records. Based on records review, and staff and resident interviews, there is insufficient evidence to substantiate the allegations mentioned above. Based on resident interviews, 3 out of 5 residents stated they do not have any injuries caused by staff. Residents stated that staff have never touches them inappropriately or handle them in a rough manner. Residents reported they are properly fed and have no concerns with care. Based on staff interviews, staff (S1) denied the allegations mentioned above, stating that he never touches any residents inappropriately or has caused any injuries to the residents. Continued on 9099-C Unsubstantiated Moreover, residents and staff denied witnessing or knowing of any physical or verbal abuse taking place in the care home. The investigation revealed that resident (R1) is diagnosed of dementia and suffers from confusion, disorientation, and inappropriate behavior. As a result of the investigation, LPA finds the allegation above to be UNSUBSTANTIATED- A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and a copy of the report was provided upon exit.the state’s words, verbatim · CDSS document, Jul 16, 2024 · control 27-AS-20240521234725

Type of visit: Case Management - Other

On 7/16/24, Licensing Program Analyst (LPA) Tung Truong arrived unannounced to conduct a case management visit. LPA met with Administrator Fernando Paramo and explained the purpose of the visit. The purpose of this case management visit is to follow up on an audio/video recording LPA Truong received from Esther on 6/9/24 to ensure personal rights were being followed. Previously, LPA Truong and Investigator Barajas made a visit to the facility on 6/4/2024 and interviewed R1. In the recording, resident (R1) can be heard alleging LPA Truong and IB’s Investigator Juan Barajas of being rude to her and of trying to hurt her, and take away her money, house, and her property. During today’s visit, LPA Truong interviewed staff (S1) and Administrator Fernando Paramo. Based on staff interviews, it was learned that S1 has not seek permission from R1 to record nor did R1 gave consent for S1 to record. Staff S1 stated that R1 is aware that S1 is recording. Resident R1 is no longer residing in this facility to provide a statement. As a result, deficiencies were cited during today’s visit pursuant to Title 22 rules and regulations, Health and Safety Codes. An exit interview was conducted, a copy of this report, LIC 809-D and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jul 16, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Jul 23, 2024

Personal Rights of Residents in All Facilities (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This is not met as evidenced by: Based on interview and record review, the facility did not comply with the section cited above. The facility did not seek R1’s permission nor have R1’s consent to recording. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 16, 2024

Plan of correction: Licensee shall review Title 22 Regulations, Section 87468.1 Personal Rights of Residents in All Facilities and submit a written statement stating knowledge of, understanding of regulation 87468.1. Correction due 7/23/24.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Victoria Brown arrived announced on 10/12/23 at 5:00pm and met with Applicant Fernando Paramo and stated the purpose of the visit. This visit is to conduct a Pre-Licensing Inspection. LPA was allowed entry into the home that will be licensed for a capacity of 6. LPA and Fernando Paramo toured and inspected the physical plant inside and outside to ensure there are no health and safety concerns. LPA observed the kitchen area, dining area, bedrooms, bathroom, storage areas, back yard and laundry rooms. LPA observed knives/sharps area to be locked. LPA observed required furniture, and lighting throughout the facility. The hot water temperature measured at 115.5 *F which is within the required range of 105-120*F. The temperature inside the facility measured at 76*F which is within the required range of 68-85*F. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The first aid kit included supplies such as sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA observed area for centrally stored medications to be locked. LPA observed the fire extinguisher(s), smoke and carbon monoxide detector(s) and exit alarms on every door in the home. Facility has central heating and air. LPA observed the area where the staff and resident files will be locked and readily available for review. Component III conducted - There are no objections to licensure at this time. -Licensure pending. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations cited during this visit. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 12, 2023