La Cruz Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Linda Cruz. Caregiver Rose Earlywine later joined the visit. According to the facility’s license, the facility has a maximum capacity of eight(8) residents, of whom all may be non-ambulatory and six(6) may be bedridden. The facility also has an approved hospice waiver for six(6) residents. LPA, accompanied by caregiver Rose Earlywine, toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Hot water a taps accessible to residents were compliant. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. No pool or body of water was present. Per Linda, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present and services within the last twelve(12) months. First aid kit(s) were complete and readily accessible. Resident records reviewed had required documentation. Staff records contained the required documents. [Cont. on LIC 809-C] [Cont. from LIC 809] No deficiencies were cited during todays visit. An exit interview was conducted with Caregiver Rose Earlywine and Administrator Linda Cruz, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jun 1, 2026

Allegation investigated: Staff do not ensure residents incontinence care needs are being met Staff do not ensure residents receive clean bedsheets Staff did not ensure infection control guidelines were being followed Staff do not ensure residents care plans are being followed Staff do not ensure residents medications are properly managed Staff do not ensure residents receive medications as prescribed

Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to open a complaint on the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with Sarah Balverde, Staff to discuss the purpose of the visit. LPA conducted conducted a tour of the facility, and conducted interviewes. It was alleged that staff do not ensure residents incontinence care needs are being met. Interviews and LPA observations revealed after inspecting all the bedrooms of the facility, all rooms appeared clean and sanitary. There were no malodors observed or any staining observed. Interviews with an outside source revealed that the staff is always on top of their parent's incontinence care. Interviews also revealed that they have not observed their parent unclean or unsanitary. Interviews revealed that staff change the residents diapers whenever they need it to be changed. Interviews revealed that they are changed whenever they ask a staff and it was revealed that there hasn't been a time where they were left to sit in a diaper too long. Unsubstantiated It was alleged that staff do not ensure residents receive clean bedsheets. Interviews and observations revealed the bedsheets appeared clean, no staining or dried urine was observed. Interviews revealed that staff keep the bedrooms clean. Interviews with outside sources revealed that the staff is on top of cleaning. It was alleged that staff did not ensure infection control guidelines were being followed. Interviews revealed that the staff follow their infection control policy by wearing gloves and masks when needed. Interviews revealed they clean and sanitize the facility with bleach. Interviews revealed that they disinfect the walls and doorknobs to keep the facility clean and the residents safe. It was alleged that staff do not ensure residents care plans are being followed. Interviews revealed that staff do a "good job" taking care of them. Interviews revealed that that the staff follow their care plans and they have no complaints about the staff. Interviews with an outside source revealed that the care plans that they have observed while working with the residents show that the staff are following them. Interviews with the outside source revealed they have not observed a care plan that they created not being followed. It was alleged that staff do not ensure residents medications are properly managed. Interviews revealed the residents get their medications and don't have any issues getting the medications. Interviews with an outside source revealed they have observed the staff assist the residents with medications and that the residents they work with have not had any medication issues. LPA observation showed the medications are reordered in time for the residents not to run out of medications and LPA observed documents to show when the orders were refilled. It was alleged that staff do not ensure residents receive medications as prescribed. Interviews revealed the residents get their medications and don't have any issues getting the medications. Interviews with staff revealed they manage the medications how they were trained and they give the medications according to the doctors orders. Based on the evidence obtained from interviews, the complaint allegations are unsubstantiated. The allegations may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Sarah Balverde, Staff and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Apr 23, 2026 · control 08-AS-20260128081232

Allegation investigated: Licensee did not meet residents' incontinence care needs. Licensee did not meet food service requirements.

Licensing Program Analyst(LPA) Janet Ngallo conducted an unannounced visit to initiate a complaint investigation and deliver findings regarding the above-mentioned complaint allegations. LPA introduced themselves and disclosed the purpose of the visit and elements of the complaint to Administrator Linda Cruz. On 04/13/2026, it was alleged that the licensee did not meet residents' incontinence care needs, and that the licensee did not meet food service requirements. The department's investigation consisted of interviews, records review, and LPA observation. (Cont. on LIC 9099-C) Unsubstantiated (Cont. from LIC 9099) Regarding the allegation that the licensee did not meet residents' incontinence care needs, it was alleged that overnight coverage left residents soiled and wet overnight. Interviews did not corroborate the allegation, as staff and residents consistently stated that residents are changed every two(2) hours or as needed, overnight and throughout the day. Staff who worked the morning following the alleged incident reported that residents were changed promptly at the start of their shift and that residents had a normal amount of overnight incontinence consistent with a typical 2-hour window. Residents interviewed reported that they are changed regularly and do not remain wet or soiled for prolonged periods. Some residents were unable to be qualified as valid historians for interview due to cognition. Records reviewed of the facility’s brief-changing logs from past months consistently showed routine incontinence checks documented every 2 to 4 hours. Review of current residents’ care plans indicated that residents requiring incontinence care or hospice care are to be changed as needed and assisted with toileting every 2 hours, with service boxes checked to indicate provided care. LPA observed multiple resident rooms that contained adequate incontinence supplies, including briefs and wipes. Regarding the allegation that the licensee did not meet food service requirements, it was alleged that residents at the facility were not receiving dinner. Interviews did not corroborate the allegation, as interviews were consistent in reporting that meals are provided three times daily and that residents have not experienced missed meals. A resident interview stated that meals are served regularly, and they have never missed a meal since moving into the facility. Staff interviews further confirmed that breakfast, lunch, and dinner are prepared and served daily, with meals adjusted based on residents’ schedules and preferences. Staff reported that refusals are documented and that alternative meals or snacks are offered at any time residents request them. Staff also reported that dinner is always provided, and they were not aware of any incidents in which a resident did not receive an evening meal. Records review supported staff statements. Review of food purchase receipts from April 2026 showed multiple groceries purchased across various food groups. LPA observations revealed fully stocked refrigerators and freezers with no expired food noted. Based on interviews, observations, and records review, the preponderance of evidence standard has not been met, therefore the above allegations are found to be unsubstantiated. An exit interview was conducted with Administrator Linda Cruz and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided. Their signature confirms receipts of these documents.the state’s words, verbatim · CDSS document, Apr 21, 2026 · control 08-AS-20260413103528

Allegation investigated: Staff did not display required job skill/competence.

Licensing Program Analyst (LPA) Iby Strong contacted Administrator Linda Cruz via telephone to deliver findings on the above-mentioned allegation. On October 6, 2025, Community Care Licensing (CCL) received a complaint alleging Administrator is showing signs of forgetfulness when it comes to resident care, including directions given to staff and medication administration. During the investigation, the LPA Strong conducted multiple internal and external interviews and reviewed outside source records. Multiple conversations between LPA Strong and Administrator revealed that they do have some signs of forgetfulness. Including Administrator not remembering conversations had with LPA. No records collected, or outside source interviews revealed that Administrator has made mistakes with resident medication administration. Additionally, no staff interviews revealed that staff have received misdirection from Administrator for care of the residents. Unsubstantiated Lastly, a completed form LIC503 Health Screening Report signed by a Doctor of Medicine on 12/22/2025 established Administrator has no health condition that would create a hazard to the person, clients, children or other persons and Administrator is within normal limits. Based on interviews and records, there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Administrator Linda Cruz, to whom a copy of this report, and the Licensee/Appeal Rights were provided to via email.the state’s words, verbatim · CDSS document, Jan 2, 2026 · control 08-AS-20251006105409

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Plan of Correction (POC) visit regarding a deficiency that was cited on 10/17/2025. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Co-Owner Henry Cruz. Administrator Linda Cruz arrived later in the visit. On 10/17/2025, the facility was cited for no background clearance for multiple staff including Staff 1 (S1). The Departments system shows that S1 was not cleared as of today 12/19/25 and evidence shows S1 has been present at the facility routinely. The system shows that other staff mentioned on the visit from 10/17/2025 have been cleared. Due to the Department failure to review plan of correction timely, the facility will be issued another POC date to submit proof of clearance for S1. Additionally, during today's visit, medication cart and cabinet were observed to be unlocked. Statement from Licensee revealed License regularly leaves medication cart unlocked but will occasionally lock the door of the room. On today's date, both the door of the medication room, the medication cart and the medication cabinet were unlocked. It was also observed on the facility schedule that two new employees have not been associated to the facility (S2 and S3). Licensee states that S2 has worked 3 shifts and S3 has worked multiple shifts since November 2025. Based on findings of today's visit, LPA Strong issued an additional extension for the original POC from 10/17/2025 for S1, and issued two additional citations for unlocked medication and additional not associated staff working at the facility(S2,S3) in which an immediate civil penalty has been issued and a repeat violation penalty. An exit interview was conducted with Administrator Linda Cruz to whom a copy of this report along with LIC811, LIC421IM, and LIC421 BG were provided. Their signature below confirms receipt of these documentsthe state’s words, verbatim · CDSS document, Dec 19, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Dec 22, 2025

87355 (e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility (3) Request a transfer of a criminal record clearance... Based on records reviewed the licensee did not obtain a criminal record clearance transfer two additional staff at the facility which poses an immediate Safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: Licensee agrees staff will receive their clearance transfer by 12/22/2025 by end of business and S1, S2, S3 will not be allowed to work on the premises until clearance is fully complete.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(2) · Plan of correction due date: Dec 19, 2025

87465(h)(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. Based on records reviewed the licensee did not keep medication locked and inaccessible to persons in care which poses an immediate Safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: Corrections have been made, Licensee stated will provide a copy of key for medication cart to staff and maintain medication continously locked and inaccessible to residents in care. LPA Strong observed medication to be locked prior to leaving facility.

Allegation investigated: Licensee did not keep medications stored in original packaging. Licensee did not give medications as prescribed. Licensee allowed staff to work before fully meeting background clearance requirements.

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced complaint visit to deliver findings in the above-mentioned allegations. LPA met with Administrator Linda Cruz and discussed the purpose of the visit. Community Care Licensing (CCL) received a complaint alleging licensee did not keep medication stored in original packaging, licensee did not give medication as prescribed, and licensee allowed staff to work before fully meeting background clearance requirements. During the investigation, LPA Strong conducted interviews, conducted a facility inspection and reviewed facility records. According to the first allegation, on October 3rd, 4th and 5th, license pre-poured multiple doses of medications for residents. Evidence collected revealed that on October 5th, 2025, at 3:19pm, there were morning, noon/dinner, and bedtime medications removed from their original contained and placed in serving cups to be administered at a later time. Substantiated Interviews with multiple staff revealed that they observed the pre-poured medication on such dates. Interview with licensee established that this information was not true. It was also alleged that licensee did not issue Resident 1’s (R1) medication as prescribed. According to R1’s Physician Report, R1 is unable to administer own medication. Interview with multiple staff revealed that Licensee has instructed staff to issue R1’s narcotic pain medication all at once. Medical prescription revealed that R1 is to receive narcotic pain medication as-needed every four hours. On October 11, 2025, at 8am, LPA Strong observed the medication administration record (MAR) which showed that on October 11, 2025, R1 had issued five doses of their as-needed pain medication all at once. Interviews also revealed that R1 is allowed to store their pre-issued medication in candy containers. Lastly, it was alleged that multiple staff have been allowed to work prior to meeting their background clearance requirements. Staff schedule collected and medication administration records show there were multiple staff who were not part of the facility roster. Department system records reviewed revealed there were four staff who have not been associated with the facility and one adult who resides at the address who does not have background clearance completed. Based on interviews, records reviewed and observations, a preponderance of evidence exists to support the allegations. Deficiencies are being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). Additionally, an immediate civil penalty has been issued. An exit interview was conducted with Administrator Linda Cruz, to whom a copy of this report, LIC 9099-C, LIC 9099-D, LIC421 and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.the state’s words, verbatim · CDSS document, Oct 17, 2025 · control 08-AS-20251006105409

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Oct 17, 2025

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department. Requirement has not been met as in evidence: Based on records reviewed the licensee did not obtain a criminal record clearance in one person residing at the facility which poses an immediate Safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 17, 2025

Plan of correction: Licensee agrees staff will receive their fingerprints by 10/17/2025 by end of business and provide LPA proof.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87355(e)(3) · Plan of correction due date: Oct 17, 2025

87355 (e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or Requirement has not been met as in evidence: Based on records reviewed the licensee did not obtain a criminal record transfer in four persons working at the facility which poses an potential Safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 17, 2025

Plan of correction: Licensee agrees staff will be associated by the end of business today, 10/17/25 and provide LPA proof of such.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(5) · Plan of correction due date: Oct 17, 2025

87465(h) The following requirements shall apply to medications which are centrally stored:(5)Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. Requirement was not met as in evidecnce: Based on records reviewed and interviews the licensee did not store medication in original containers which poses an potential Safety risk to persons in care. · Type B – “posed a potential Health, Safety, or Personal Rights risk to persons in care.”the state’s words, verbatim · CDSS document, Oct 17, 2025

Plan of correction: Licensee states they will schedule outside source medication training and provide proof to LPA by end of business day today.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(2) · Plan of correction due date: Oct 17, 2025

87465(b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication. Based on records reviewed and interviews the licensee did not assist R1 with PRN medication as prescribed which posed a potential Safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 17, 2025

Plan of correction: Licensee states they will schedule outside source medication training and provide proof to LPA by end of business day today.

Allegation investigated: Insufficient staffing to meet resident's needs Staff did not administer medication as prescribed Licensee did not seek medical attention for resident Staff are not properly trained to administer medications Infectious material is not being discarded immediately There are no activities for the residents

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced complaint visit to initiate an investigation in the above-mentioned allegations. LPA met with Administrator Linda Cruz and discussed the purpose of the visit. On July 16, 2025, Community Care Licensing (CCL) received a complaint alleging licensee did not seek medical attention for Resident 1 (R1), Insufficient staffing to meet resident's needs, Staff did not administer medication as prescribed, Staff are not properly trained to administer medications, Infectious material is not being discarded immediately and there are no activities for the residents. During the investigation, LPA Strong conducted interviews, conducted a facility inspection and reviewed facility records. According to the allegation on an undisclosed date, about two months prior to the report, Resident 1 (R1) had a witnessed fall and did not receive medical attention. Unsubstantiated According to interviews, R1 had an witnessed fall that resulted in a bruise, R1 was actively receiving end-of-life services, and an outside source agency was contacted to evaluate R1 post fall. Records collected revealed that R1 was visited by outside source agency to be evaluate for fall and was found to be a bruise. Interview with Administrator revealed that after R1 complained of further pain, Administrator advocated for R1 to receive imaging where it was found that R1 had a fracture. After correct diagnosis, R1 received pain medication but no further medical treatment was chosen by R1. It was also alleged that facility does not staff enough employees to meet the residents’ needs. Schedule collected revealed that there are two present staff during day shifts and one staff on overnight shifts. Records collected revealed that there are no two person assist residents present at the facility. Interviews with staff revealed that they feel adequately staffed. Interview with outside sources confirmed that there are usually a minimum of two staff present during the day. The third allegation states that R1 did not receive one does of morphine on an undisclosed date. Medical administration records (MAR) revealed that R1 receives morphine numerous times a day and is prescribed morphine as both as needed prescription and a routine prescription. Interviews with staff did not reveal any information that R1 did not receive a dose of their routine medication. Review of MAR did not reveal any routine doses missed. The fourth allegation states that staff are not trained to administer medication. Records collected revealed that all staff have received medication management training within the last month from an outside source agency. Interviews with multiple residents established that they receive their medication timely and regularly. Interview with outside sources established that they have not witnessed any medication mismanagement or untrained staff issuing medication. Interview with Administrator established that if a staff member is not comfortable with issuing medication, the Administrator will issue medication to residents in care. The fifth allegation states that soiled undergarments and urine-soaked bedding were being left in the resident’s room for extended period of time. On today’s date, LPA Strong conducted a facility inspection and did not observe any waste containers with the items mentioned above, in addition, LPA did not smell any malodors anywhere within the facility. Lastly, interviews with staff revealed that it is mandatory for them to dispose of any soiled undergarments soon after they are removed from a resident. Multiple interviews with outside sources revealed that there have been no witnessed events of overly full trash or malodors in the facility. Lastly, it was alleged that there are no activities for residents. Interview with multiple residents revealed that they are offered numerous activities throughout the day but often refuse to do them. Interview with staff established that resident activities include board games, gardening, walks, manicures and stretching. Interview with outside sources revealed that there are no concerns regarding the activities available to residents in care. Based on interviews, and record reviews there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Administrator, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jul 18, 2025 · control 08-AS-20250716094136

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Iby Strong conducted a Case Management Visit during an unannounced Complaint Visit. LPA met with Administrator Linda Cruz and discussed the purpose of the visit. During a complaint investigation, LPA discovered, through interviews and observations that the facility has seven residents in care and does not have a posting of planned activities. During the investigation it was also found that Administrator did not report an witnessed fall to the Department that resulted in a serious injury. Based on this information, two deficiencies are being cited Per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on an LIC 809-D. An exit interview was conducted and a copy of the report, Licensee/Appeal Rights (LIC9058 03/22) were provided to Administrator .the state’s words, verbatim · CDSS document, Jul 18, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(B) · Plan of correction due date: Aug 8, 2025

87211 (a)... licensee shall furnish to the licensing agency... reports.... including, but not limited to, the following: (1)A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events (B) Any serious injury as determined by the attending physician This requirement was not met as in evidence; Based on observations and records reviewed the licensee did not report a serious injury to the department in one of seven residents in care which posed a potential Personal Rights risk to persons in carethe state’s words, verbatim · CDSS document, Jul 18, 2025

Plan of correction: Licensee states they will review reporting requirement regulations and provide LPA with a writtten statement of understanding.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87219(d) · Plan of correction due date: Aug 8, 2025

(d)In facilities licensed for seven (7) or more persons, notices of planned activities shall be posted in a central location readily accessible to residents, relatives, and representatives..copies shall be retained for 6 months This requirement was not met as in evidence; Based on observations and records reviewed the licensee post activitiesfor all seven residents in care which posed a potential Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 18, 2025

Plan of correction: Licensee states they will create a calendar and provide such to LPA by POC date.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Case Management Visit to observe the physical plant. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Linda Cruz. On 5/13/2025, the Licensee submitted an LIC200 Application to the CCLD San Diego Regional Office (RO) requesting to increase the facility's total licensed capacity from six (6) residents up to eight (8) residents. The facility’s floor plan changed in that the former office is now bedroom #6, meant to accommodate two (2) non-ambulatory residents. On 6/5/2025, the local fire authority approved/granted an updated fire clearance, reflecting the facility was approved from six (6) residents up to eight (8) residents, with six (6) of those residents being bed-ridden and two (2) non-ambulatory. During today’s visit, LPA briefly toured the interior and exterior of the facility. The facility sketch/floor plan was consistent with the current layout of the facility. No deficiencies were cited for this increase capacity visit. This portion of the application process has been completed. The Licensee will be sent an updated license to reflect the new fire clearance after CCLD management’s final review and approval. An exit interview was conducted with Administrator, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jun 13, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Linda Cruz. According to the facility’s license, the facility has a maximum capacity of six residents, of whom all may be non-ambulatory and six may be bedridden. LPA toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were observed to be pre-poured in cups for the following two days, with incorrect dates marked. Medication administration records for today's morning was not filled in. No pool or body of water is present. Per Linda, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher were present. First aid kit was complete and readily accessible. Resident records reviewed had required documentation. Five out six resident's needs and services plans were complete but not signed by resident or responsible party. Staff records reviewed did contain required documentation Two technical violations were issued today for records and one deficiency was cited per California Code of Regulations. An exit interview was conducted with Administrator, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22), LIC809 D and LIC9102 x2 were provided to.the state’s words, verbatim · CDSS document, Jun 13, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Linda Cruz. According to the facility’s license, the facility has a maximum capacity of six residents, of whom all may be non-ambulatory and six may be bedridden. LPA toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. No pool or body of water is present. Per Linda, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Resident records reviewed had required documentation. Staff records reviewed did not contain medication management training. One technical advisory was issued today for training. No additional deficiencies were cited on todays visit. An exit interview was conducted with Administrator, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jun 12, 2024

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Case Management visit to follow-up on an incident reported to Community Care Licensing. LPA met with Administrator Linda Cruz. Community Care Licensing received an incident report on 4/15/24 in which it was reported that Resident #1 (R1) had an witnessed fall on 4/12/24. There was an additional report received in the regional office on 5/2/24 which gave additional information regarding the same incident on 4/12/24. During today's visit, LPA collected records, conducted a health and safety check of the residents in care and provided consultation. No deficiencies were cited during today’s visit. An exit interview was conducted with Administrator Linda Cruz who was also provided a copy of their appeal rights (LIC9058 03/22),this report and their signature on this form, acknowledges receipt of these rights.the state’s words, verbatim · CDSS document, May 3, 2024